Elliot E R, Singh S, Tyebally S, Gedela K, Nelson M
HIV/GUM Directorate, Chelsea and Westminster Hospital, London, UK.
Sexual Health Service Greenway Centre, Newham General Hospital, London, UK.
HIV Med. 2017 Aug;18(7):525-531. doi: 10.1111/hiv.12487. Epub 2017 Jan 24.
While a high rate of recreational drug use (RDU) has been documented among HIV-infected out-patients, particularly in men who have sex with men (MSM), there is a distinct lack of data for HIV-infected in-patients. Hospital admission offers a unique opportunity to engage drug users. We aimed to establish and characterize RDU among new admissions to a large dedicated London HIV in-patient unit and compare it to RDU among general medical admissions to inform clinical pathways.
A prospective opt-out survey was administered to all new HIV-positive admissions over a 10-week period (cases) and all medical Acute Assessment Unit admissions over two 24-h periods (controls). All provided consent for urine toxicology upon admission.
Data were collected in 59 of 65 (91%) newly admitted HIV-positive individuals and in 48 of 54 (89%) non-HIV-positive medical admissions. HIV-infected in-patients were more likely than non-HIV-positive medical admissions to be male (P < 0.0001) (71% MSM), to be younger (P < 0.0001), to report current RDU (41 vs. 10%, respectively; P = 0.0001), to have a positive urine toxicology screen (19 vs. 2%, respectively; P = 0.0091) and to be a drug-related admission (15% vs. none; P = 0.004). Thirteen of 26 HIV-infected current recreational drug users admitted to sexualized drug taking and nine to injecting drugs. Twenty-seven per cent (seven of 26) were known to drug services. Crystal methamphetamine, mephedrone, gamma butyrolactone/gamma hydroxybutyrate and ketamine were exclusively taken by MSM. In total, 13 of 59 HIV-infected in-patients had current or past infection with hepatitis C virus, of whom 92% reported lifetime drug use.
These data strongly support the use of formal screening and drug service referral pathways at the time of admission to hospital to engage HIV-positive drug users.
虽然在艾滋病毒感染的门诊患者中，尤其是在男男性行为者（MSM）中，娱乐性药物使用（RDU）率较高，但艾滋病毒感染住院患者的数据明显不足。住院为接触吸毒者提供了一个独特的机会。我们旨在确定并描述伦敦一家大型专门艾滋病毒住院病房新入院患者中的RDU情况，并将其与普通内科入院患者中的RDU情况进行比较，以为临床路径提供参考。
在10周内对所有新确诊的艾滋病毒阳性入院患者（病例组）以及在两个24小时期间对所有内科急性评估病房入院患者（对照组）进行前瞻性选择退出式调查。所有患者入院时均同意进行尿液毒理学检测。
65名新确诊的艾滋病毒阳性患者中有59名（91%）、54名非艾滋病毒阳性内科入院患者中有48名（89%）收集到了数据。艾滋病毒感染住院患者比非艾滋病毒阳性内科入院患者更有可能为男性（P<0.0001）（71%为男男性行为者）、更年轻（P<0.0001）、报告当前有娱乐性药物使用情况（分别为41%和10%；P = 0.0001）、尿液毒理学筛查呈阳性（分别为19%和2%；P = 0.0091）以及因药物相关原因入院（15%对无；P = 0.004）。26名当前有娱乐性药物使用的艾滋病毒感染患者中有13名承认有性相关药物使用，9名承认有注射吸毒。27%（26名中的7名）为药物服务机构已知人员。甲基苯丙胺、甲麻黄碱、γ-丁内酯/γ-羟基丁酸酯和氯胺酮仅在男男性行为者中使用。59名艾滋病毒感染住院患者中共有13名有当前或既往丙型肝炎病毒感染，其中92%报告有终身吸毒史。
这些数据有力支持在入院时使用正式筛查和药物服务转诊途径来接触艾滋病毒阳性吸毒者。
