Infectious Diseases Unit, Tel Aviv Sourasky Medical Centre and Sackler School of Medicine, Tel Aviv University, Israel.
Infectious Diseases Unit, Tel Aviv Sourasky Medical Centre and Sackler School of Medicine, Tel Aviv University, Israel.
Clin Microbiol Infect. 2017 May;23(5):336.e5-336.e8. doi: 10.1016/j.cmi.2016.11.009. Epub 2016 Nov 20.
Outbreaks of HIV infection have been linked to injectable drug abuse, but specific triggers often remain obscure. We report on an outbreak of primary HIV infection among people who inject drugs (PWID) in Tel Aviv, associated with a local shift in drug-use practices.
A cluster of primary HIV infection cases in PWID was detected in May 2012. Retrospective and prospective multi-hospital case finding was initiated. PWID were interviewed and risk factors for primary HIV infection were identified. Starting in December 2012, a multifaceted intervention was implemented, including educational activities, increasing syringe exchange supplies, active screening, early initiation of antiretroviral therapy, and referral to drug withdrawal programmes.
Forty-two PWID with primary HIV infection were detected between May 2012 and April 2013. Compared with the corresponding pre-outbreak period, the annual incidence of primary HIV infection in PWID increased from 0 to 20 cases/1000 population (p <0.0001). Sixty-nine per cent were hospitalized because of concomitant bacterial infections and sepsis. Phylogenetic analysis of HIV isolates from case patients showed tight clustering suggesting a single common source of infection. The outbreak was temporally related to a widespread shift from heroin to injectable cathinone-derivatives and buprenorphine, which entailed high-risk injection practices. Targeted intervention resulted in a dramatic and sustained reduction in HIV infection in the PWID population.
Injectable amphetamines are gaining momentum among PWID worldwide. Tracing of this outbreak to cathinone use and implementing a targeted intervention programme effectively terminated the outbreak.
艾滋病毒感染的爆发与注射吸毒有关，但具体的触发因素往往仍不清楚。我们报告了在特拉维夫注射吸毒者（PWID）中发生的与当地吸毒习惯变化相关的原发性 HIV 感染爆发。
2012 年 5 月发现了一批原发性 HIV 感染的 PWID 病例。启动了回顾性和前瞻性多医院病例发现。对 PWID 进行了访谈，并确定了原发性 HIV 感染的危险因素。从 2012 年 12 月开始，实施了多方面的干预措施，包括教育活动、增加注射器交换用品、主动筛查、早期开始抗逆转录病毒治疗以及转介至戒毒方案。
在 2012 年 5 月至 2013 年 4 月期间发现了 42 例原发性 HIV 感染的 PWID。与相应的爆发前时期相比，PWID 中原发性 HIV 感染的年发病率从 0 例/1000 人增加到 20 例/1000 人（p<0.0001）。69%的患者因合并细菌感染和败血症住院。对病例患者的 HIV 分离株进行系统发育分析表明，紧密聚集提示存在单一的共同感染源。该爆发与从海洛因到注射用苯丙胺类和丁丙诺啡的广泛转变有关，这涉及到高风险的注射行为。有针对性的干预措施导致 PWID 人群中 HIV 感染率显著且持续下降。
在全球范围内，PWID 中注射苯丙胺类兴奋剂的使用率正在上升。追踪到这次爆发与苯丙胺的使用，并实施了有针对性的干预方案，有效地终止了这次爆发。
