Des Jarlais Don C, Kerr Thomas, Carrieri Patrizia, Feelemyer Jonathan, Arasteh Kamyar
aBaron Edmond de Rothschild Chemical Dependency Institute, Icahn School of Medicine at Mount Sinai, New York City, New York, USA bUrban Health Research Initiative British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada cINSERM, U912 (SESSTIM), Marseille, France.
AIDS. 2016 Mar 27;30(6):815-26. doi: 10.1097/QAD.0000000000001039.
AIDS among persons who inject drugs, first identified in December 1981, has become a global epidemic. Injecting drug use has been reported in 148 countries and HIV infection has been seen among persons who inject drugs in 61 countries. Many locations have experienced outbreaks of HIV infection among persons who inject drugs, under specific conditions that promote very rapid spread of the virus. In response to these HIV outbreaks, specific interventions for persons who inject drugs include needle/syringe exchange programs, medicated-assisted treatment (with methadone or buprenorphine) and antiretroviral therapy. Through a 'combined prevention' approach, these interventions significantly reduced new HIV infections among persons who inject drugs in several locations including New York City, Vancouver and France. The efforts effectively ended the HIV epidemic among persons who inject drugs in those locations. This review examines possible processes through which combined prevention programs may lead to ending HIV epidemics. However, notable outbreaks of HIV among persons who inject drugs have recently occurred in several countries, including in Athens, Greece; Tel-Aviv, Israel; Dublin, Ireland; as well as in Scott County, Indiana, USA. This review also considers different factors that may have led to these outbreaks. We conclude with addressing the remaining challenges for reducing HIV infection among persons who inject drugs.
1981年12月首次确认的注射吸毒者中的艾滋病已成为一种全球流行病。148个国家报告存在注射吸毒现象，61个国家的注射吸毒者中发现了艾滋病毒感染情况。在促进病毒快速传播的特定条件下，许多地方都出现了注射吸毒者中的艾滋病毒感染疫情。针对这些艾滋病毒疫情，针对注射吸毒者的具体干预措施包括针头/注射器交换项目、药物辅助治疗（使用美沙酮或丁丙诺啡）和抗逆转录病毒疗法。通过“综合预防”方法，这些干预措施在包括纽约市、温哥华和法国在内的多个地方显著减少了注射吸毒者中的新艾滋病毒感染。这些努力有效地结束了这些地方注射吸毒者中的艾滋病毒流行。本综述探讨了综合预防项目可能导致结束艾滋病毒流行的潜在过程。然而，最近在几个国家，包括希腊雅典、以色列特拉维夫、爱尔兰都柏林以及美国印第安纳州斯科特县，出现了注射吸毒者中的显著艾滋病毒疫情。本综述还考虑了可能导致这些疫情的不同因素。我们最后讨论了在减少注射吸毒者中的艾滋病毒感染方面仍然存在的挑战。
