Des Jarlais Don C, Arasteh Kamyar, McKnight Courtney, Feelemyer Jonathan, Campbell Aimee N C, Tross Susan, Cooper Hannah L F, Hagan Holly, Perlman David C
Icahn School of Medicine at Mount Sinai, New York, NY, USA.
New York State Psychiatric Institute, Department of Psychiatry, Columbia University Medical Center, New York, NY, USA.
Addiction. 2017 Feb;112(2):290-298. doi: 10.1111/add.13601. Epub 2016 Nov 14.
HIV has reached high prevalence in many non-injecting drug user (NIDU) populations. The aims of this study were to (1) examine the trend in HIV prevalence among non-injecting cocaine and heroin NIDUs in New York City, (2) identify factors potentially associated with the trend and (3) estimate HIV incidence among NIDUs.
Serial-cross sectional surveys of people entering drug treatment programs. People were permitted to participate only once per year, but could participate in multiple years.
Mount Sinai Beth Israel drug treatment programs in New York City, USA.
We recruited 3298 non-injecting cocaine and heroin users from 2005 to 2014. Participants were 78.7% male, 6.1% white, 25.7% Hispanic and 65.8% African American. Smoking crack cocaine was the most common non-injecting drug practice.
Trend tests were used to examine HIV prevalence, demographics, drug use, sexual behavior and use of antiretroviral treatment (ART) by calendar year; χ and multivariable logistic regression were used to compare 2005-10 versus 2011-14.
HIV prevalence declined approximately 1% per year (P < 0.001), with a decline from 16% in 2005-10 to 8% in 2011-14 (P < 0.001). The percentages of participants smoking crack and having multiple sexual partners declined and the percentage of HIV-positive people on ART increased. HIV incidence among repeat participants was 1.2 per 1000 person-years (95% confidence interval = 0.03/1000-7/1000).
HIV prevalence has declined and a high percentage of HIV-positive non-injecting drug users (NIDUs) are receiving antiretroviral treatment, suggesting an end to the HIV epidemic among NIDUs in New York City. These results can be considered a proof of concept that it is possible to control non-injecting drug use related sexual transmission HIV epidemics.
在许多非注射吸毒者（NIDU）群体中，HIV感染率已达到很高水平。本研究的目的是：（1）调查纽约市非注射可卡因和海洛因的非注射吸毒者中HIV感染率的变化趋势；（2）确定与该趋势潜在相关的因素；（3）估计非注射吸毒者中的HIV发病率。
对进入戒毒治疗项目的人员进行系列横断面调查。每人每年仅允许参与一次，但可参与多年。
美国纽约市西奈山贝斯以色列戒毒治疗项目。
2005年至2014年期间，我们招募了3298名非注射可卡因和海洛因使用者。参与者中男性占78.7%，白人占6.1%，西班牙裔占25.7%，非裔美国人占65.8%。吸食强效可卡因是最常见的非注射吸毒方式。
采用趋势检验按历年检查HIV感染率、人口统计学特征、吸毒情况、性行为及抗逆转录病毒治疗（ART）的使用情况；采用χ检验和多变量逻辑回归比较2005 - 10年与2011 - 14年的情况。
HIV感染率每年下降约1%（P < 0.001），从2005 - 10年的16%降至2011 - 14年的8%（P < 0.001）。吸食强效可卡因和有多个性伴侣的参与者比例下降，接受ART治疗的HIV阳性者比例增加。重复参与者中的HIV发病率为每1000人年1.2例（95%置信区间 = 0.03/1000 - 7/1000）。
HIV感染率已下降，且高比例的HIV阳性非注射吸毒者正在接受抗逆转录病毒治疗，这表明纽约市非注射吸毒者中的HIV流行已结束。这些结果可被视为一个概念验证，即有可能控制与非注射吸毒相关的性传播HIV流行。
