Centers for Disease Control, Ministry of Health and Welfare, Taipei, Taiwan.
Department of Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States of America.
PLoS One. 2019 Feb 8;14(2):e0210210. doi: 10.1371/journal.pone.0210210. eCollection 2019.
The aim of this study was to report an HIV outbreak related to propofol-injection and the impact of regulating propofol on the HIV epidemic among people who inject drugs (PWID).
A retrospective cohort study of 252 PWID who were diagnosed with an HIV infection between 2014 and 2017 in Taiwan. The propofol information was collected by routine epidemic surveillance and interviews. We linked several national databases to collect other related factors, including methadone maintenance treatment (MMT) attendance and incarceration. The serums were tested for recent infection by the LAg-avidity EIA assay and relationship of the trains by the Phylogenetic tree analysis. Analyses were conducted using the R Surveillance package for retrospective modeling for outbreak detection. A multiple logistic regression was used to evaluate the association between propofol-injection and other related factors.
There were 28 cases reported with propofol-injection, all of which were reported in Central Taiwan. A total of 11 (50%) cases among 22 propofol-injectors with serums were recent infections, which were higher than that 33 (23.4%) of non-propofol group. The phylogenetic tree indicated that 6 propofol-injectors were grouped together with the same cluster in circular. The HIV epidemic curve among PWID revealed an outbreak of 82 in 2015, which then decreased to 43 in 2016 after propofol began to be regulated as a Schedule 4 controlled drug in August 2015. In a multiple logistic regression, attendance at methadone clinics was associated with a significantly higher risk for propofol-injection (adjusted OR = 2.43, 95% CI = 0.98-5.98), and HIV reported in the year 2015 was associated with an increased risk of propofol-injection (adjusted OR = 4, 95% CI = 1.08-14.86).
Our data indicate that the government regulation of propofol as a controlled drug strategy was associated with significant reduction in the spread of HIV among PWID.
本研究旨在报告与丙泊酚注射相关的 HIV 疫情，并评估管制丙泊酚对台湾地区静脉注射吸毒者（PWID）中 HIV 流行的影响。
这是一项回顾性队列研究，纳入了 2014 年至 2017 年间在台湾被诊断出 HIV 感染的 252 名 PWID。丙泊酚信息通过常规疫情监测和访谈收集。我们还链接了多个国家数据库，以收集其他相关因素，包括美沙酮维持治疗（MMT）参与和监禁情况。通过 LAg 亲和力 EIA 检测和系统进化树分析检测近期感染。使用 R 监测软件包进行回顾性建模以检测疫情。采用多因素逻辑回归评估丙泊酚注射与其他相关因素的关系。
共报告了 28 例丙泊酚注射病例，均发生在台湾中部。22 名丙泊酚注射者中有 11 例（50%）血清近期感染，高于非丙泊酚组的 33 例（23.4%）。系统进化树表明，6 名丙泊酚注射者与同一簇聚集在一起。PWID 中的 HIV 流行曲线显示，2015 年疫情爆发 82 例，2015 年 8 月丙泊酚被列为附表 4 管制药物后，2016 年降至 43 例。多因素逻辑回归分析表明，美沙酮门诊就诊与丙泊酚注射的风险显著增加相关（调整后的 OR = 2.43，95%CI = 0.98-5.98），2015 年报告的 HIV 与丙泊酚注射的风险增加相关（调整后的 OR = 4，95%CI = 1.08-14.86）。
我们的数据表明，政府将丙泊酚作为管制药物的管制策略与 PWID 中 HIV 传播的显著减少有关。
