注射可卡因与卢森堡注射吸毒者最近的 HIV 疫情有关。
Injection of cocaine is associated with a recent HIV outbreak in people who inject drugs in Luxembourg.
机构信息
Service National des Maladies Infectieuses, Centre Hospitalier de Luxembourg, Luxembourg, Luxembourg.
Department of Infection and Immunity, Luxembourg Institute of Health, Esch sur Alzette, Luxembourg.
出版信息
PLoS One. 2019 May 16;14(5):e0215570. doi: 10.1371/journal.pone.0215570. eCollection 2019.
BACKGROUND
An outbreak of HIV infections among people who inject drugs (PWID) started in 2014 in Luxembourg.
OBJECTIVES
We conducted phylogenetic and epidemiological analyses among the PWID infected with HIV in Luxembourg or attending the supervised drug consumption facility (SDCF) to understand the main causes of the outbreak.
METHODS
Between January 2013 and December 2017, analysis of medical files were performed from all PWID infected with HIV at the National Service of Infectious Diseases (NSID) providing clinical care nationwide. PWID were interviewed at NSID and SDCF using a standardized questionnaire focused on drug consumption and risk behaviours. The national drug monitoring system RELIS was consulted to determine the frequency of cocaine/heroin use. Transmission clusters were analysed by phylogenetic analyses using approximate maximum-likelihood. Univariate and multivariate logistic regression analyses were performed on epidemiological data collected at NSID and SDCF to determine risk factors associated with cocaine use.
RESULTS
From January 2013 to December 2017, 68 new diagnosis of HIV infection reported injecting drug use as the main risk of transmission at NSID. The proportion of female cases enrolled between 2013-2017 was higher than the proportion among cases enrolled prior to 2013. (33% vs 21%, p < 0.05). Fifty six viral sequences were obtained from the 68 PWID newly diagnosed for HIV. Two main transmission clusters were revealed: one HIV-1 subtype B cluster and one CRF14_BG cluster including 37 and 9 patients diagnosed since 2013, respectively. Interviews from 32/68 (47%) newly diagnosed PWID revealed that 12/32 (37.5%) were homeless and 27/32 (84.4%) injected cocaine. Increased cocaine injection was indeed reported by the RELIS participants from 53 to 63% in drug users with services contacts between 2012 and 2015, and from 5 to 22% in SDCF users between 2012 and 2016. Compared with PWID who injected only heroin (n = 63), PWID injecting cocaine and heroin (n = 107) were younger (mean of 38 vs 44 years, p≤0.001), reported more frequent piercing (≤0.001), shared and injected drugs more often (p≤0.01), and were more frequently HIV positive (p<0.05) at SDCF using univariate logistic regression analysis. Finally, in the multivariate analysis, use of heroin and cocaine was independently associated with younger age, piercing, sharing of drugs, and regular consumption (p<0.05).
CONCLUSIONS
Injecting cocaine is a new trend of drug use in Luxembourg associated with HIV infection in this recent outbreak among PWID.
背景
2014 年，卢森堡开始出现与静脉注射吸毒者（PWID）相关的 HIV 感染疫情。
目的
通过对卢森堡感染 HIV 的 PWID 或参加监督药物使用设施（SDCF）的 PWID 进行系统发育和流行病学分析，了解疫情的主要原因。
方法
2013 年 1 月至 2017 年 12 月，对全国传染病服务中心（NSID）治疗的所有 HIV 感染的 PWID 进行了医疗档案分析，为全国提供临床护理。在 NSID 和 SDCF 对 PWID 进行了采访，采用标准化问卷，重点关注吸毒和风险行为。通过咨询国家毒品监测系统 RELIS，确定可卡因/海洛因的使用频率。使用近似最大似然法对传播群进行系统发育分析。对 NSID 和 SDCF 收集的流行病学数据进行单变量和多变量逻辑回归分析，以确定与可卡因使用相关的危险因素。
结果
2013 年 1 月至 2017 年 12 月，68 名新诊断为 HIV 感染的患者报告在 NSID 注射吸毒是主要的传播风险。2013-2017 年期间，女性病例的比例高于 2013 年之前的比例（33%比 21%，p < 0.05）。从 68 名新诊断为 HIV 的 PWID 中获得了 56 个病毒序列。揭示了两个主要的传播群：一个 HIV-1 亚型 B 群和一个 CRF14_BG 群，分别包括 37 名和 9 名自 2013 年以来诊断的患者。对 32/68（47%）新诊断的 PWID 的访谈显示，12/32（37.5%）无家可归，27/32（84.4%）注射可卡因。2012 年至 2015 年，与有服务接触的吸毒者相比，RELIS 参与者报告可卡因注射率从 53%增加到 63%，2012 年至 2016 年，与 SDCF 使用者相比，可卡因注射率从 5%增加到 22%。与仅注射海洛因的 PWID（n = 63）相比，注射可卡因和海洛因的 PWID（n = 107）年龄更小（平均 38 岁比 44 岁，p≤0.001），更频繁地进行穿刺（≤0.001），更频繁地共享和注射毒品（p≤0.01），并且在 SDCF 中更常 HIV 阳性（p<0.05），这是通过单变量逻辑回归分析得到的。最后，在多变量分析中，使用海洛因和可卡因与年龄较小、穿刺、共用毒品和定期消费独立相关（p<0.05）。
结论
在卢森堡，可卡因注射是一种新的毒品使用趋势，与最近在 PWID 中爆发的 HIV 感染有关。
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