Skidmore C A, Robertson J R, Robertson A A, Elton R A
Edinburgh Drug Addiction Study, Muirhouse Medical Group, Edinburgh.
BMJ. 1990 Jan 27;300(6719):219-23. doi: 10.1136/bmj.300.6719.219.
To follow up known intravenous drug users to determine current health state and drug use, compare characteristics with those of recent drug users, and examine HIV exposure and serostate.
Subjects were identified from conventional general practice records and recruited from 1980 to the end of 1985; they were followed up during 1987 and 1988 and compared with drug users identified in the same way but recruited after 1985.
General practice and community in north west Edinburgh. Follow up conducted throughout the United Kingdom.
Subjects known to have injected illegal drugs before 1986 (n = 203) and since that time.
Mortality from and prevalence of HIV seropositivity and various parameters indicative of abstinence.
Of the 203 subjects in the follow up group, 189 (93%) were traced; 16 (8%) had died and the remaining 173 (85%) were interviewed. In all, 146 (72% of the follow up cohort) had been tested for HIV antibodies, 94 (64%) having positive and 52 (36%) negative results; 57 (28%) had not been tested. Of the 65 subjects in the recently recruited group, 51 (79%) had been tested for HIV, 15 (29%) having positive results. A further 21 (43%) were currently negative for HIV antibody but still at risk. Thirty three (19%) of those followed up were confirmed abstinent, although more (about half) showed evidence of diminished drug injecting. Age correlated strongly with abstinence (p less than 0.001). One third of the group currently used cannabis, buprenorphine, dihydrocodeine, or diazepam. When the two groups were analysed together there was a strong association between the date of starting injecting and HIV seropositivity (chi 3 = 23.81, df = 2, p less than 0.001), with a peak around 1980-3.
Although only a fifth of the followed up group were convincingly abstinent, a much larger group showed evidence of prolonged periods of remission. Overall, much use of oral drugs was confirmed and worrying trends towards taking buprenorphine and benzodiazepines were evident. The peak incidence of starting drug use and the comparatively low seroprevalence of HIV in the newer drug users probably explain the anomalous high seroprevalence in Edinburgh drug users during 1980-5. The epidemic of HIV during the first half of the 1980s in the group suggests that the virus was probably being transmitted because of a pattern of behaviour. Changing patterns of HIV transmission suggest a need to concentrate on heterosexual transmission as the main problem in the future.
对已知的静脉注射吸毒者进行随访，以确定其当前健康状况和吸毒情况，将其特征与近期吸毒者进行比较，并检查HIV暴露情况和血清状态。
从常规全科医疗记录中识别出研究对象，于1980年至1985年底招募；在1987年和1988年对他们进行随访，并与以相同方式识别但于1985年后招募的吸毒者进行比较。
爱丁堡西北部的全科医疗和社区。随访在英国全境进行。
已知在1986年之前（n = 203）及此后注射过非法药物的对象。
HIV血清阳性的死亡率和患病率以及表明戒毒的各种参数。
在随访组的203名研究对象中，追踪到了189名（93%）；16名（8%）已死亡，其余173名（85%）接受了访谈。总共有146名（随访队列的72%）接受了HIV抗体检测，其中94名（64%）结果呈阳性，52名（36%）呈阴性；57名（28%）未接受检测。在最近招募的65名研究对象中，51名（79%）接受了HIV检测，15名（29%）结果呈阳性。另外21名（43%）目前HIV抗体呈阴性但仍有感染风险。随访对象中有33名（19%）被证实已戒毒，尽管更多（约一半）显示出注射吸毒减少的迹象。年龄与戒毒密切相关（p < 0.001）。该组中有三分之一的人目前使用大麻、丁丙诺啡、二氢可待因或地西泮。当将两组一起分析时，开始注射吸毒的日期与HIV血清阳性之间存在强烈关联（χ² = 23.81，自由度 = 2，p < 0.001），在1980 - 1983年左右出现峰值。
尽管随访组中只有五分之一的人令人信服地戒除了毒瘾，但有更多的人显示出长时间缓解的迹象。总体而言，证实了口服药物的大量使用，并且明显存在服用丁丙诺啡和苯二氮䓬类药物的令人担忧的趋势。开始吸毒的高峰发病率以及较新吸毒者中相对较低的HIV血清阳性率可能解释了1980 - 1985年期间爱丁堡吸毒者异常高的血清阳性率。20世纪80年代上半叶该组中的HIV流行表明，病毒可能是由于一种行为模式而传播的。HIV传播模式的变化表明，未来需要将重点放在异性传播作为主要问题上。
