Martin Michael, Vanichseni Suphak, Sangkum Udomsak, Mock Philip A, Leethochawalit Manoj, Chiamwongpaet Sithisat, Pitisuttithum Punnee, Kaewkungwal Jaranit, van Griensven Frits, McNicholl Janet M, Tappero Jordan W, Mastro Timothy D, Kittimunkong Somyot, Choopanya Kachit
U.S. Centers for Disease Control and Prevention, Division of HIV/AIDS Prevention, Atlanta, GA, USA.
Thailand MOPH - U.S. CDC Collaboration, Nonthaburi, Thailand.
EClinicalMedicine. 2019 Apr 1;9:44-51. doi: 10.1016/j.eclinm.2019.03.012. eCollection 2019 Mar.
Three consecutive prospective studies were conducted among people who inject drugs (PWID) from May 1995 through June 2012 in Bangkok, Thailand. We examined data from these studies to evaluate HIV incidence and explore trends in risk behaviours.
We used data from a 1995-1998 cohort study, a 1999-2004 HIV vaccine trial, and a 2005-2012 HIV pre-exposure prophylaxis (PrEP) study to examine per-quarter trends in HIV incidence, using a restricted cubic spline function for time in a Poisson regression. We also examined temporal trends in HIV-associated risk behaviours.
HIV incidence declined from 5.7 per 100 person-years during the cohort study, to 2.7 per 100 person-years in the vaccine trial, to 0.7 per 100 person-years among PrEP study placebo recipients. Incidence peaked at 12.1 per 100 person-years in 1996 and declined to < 1 per 100 person-years during 2005-2012. Reports of injecting drugs and sharing needles also declined from the cohort study to the PrEP study (p < 0.0001). Heroin was the most common drug injected during the cohort study and the vaccine trial, but stimulants (e.g., methamphetamine) and sedatives (e.g., midazolam) were injected more often during the PrEP study.
HIV incidence among PWID declined during 2005-2012. Several factors likely contributed to the decline, including decreases in the frequency of injecting and sharing, improved access to HIV testing and antiretroviral therapy, and the use of PrEP. Expanding access to effective HIV prevention tools can hasten control of the HIV epidemic among PWID.
The Bangkok Metropolitan Administration and U.S. Centers for Disease Control and Prevention, Division of HIV/AIDS Prevention.
1995年5月至2012年6月期间，在泰国曼谷对注射毒品者开展了三项连续的前瞻性研究。我们分析了这些研究的数据，以评估艾滋病毒发病率并探究风险行为的趋势。
我们使用了1995 - 1998年队列研究、1999 - 2004年艾滋病毒疫苗试验以及2005 - 2012年艾滋病毒暴露前预防（PrEP）研究的数据，通过在泊松回归中使用受限立方样条函数来分析按季度划分的艾滋病毒发病率趋势。我们还研究了与艾滋病毒相关的风险行为的时间趋势。
艾滋病毒发病率从队列研究期间的每100人年5.7例，降至疫苗试验期间的每100人年2.7例，再降至PrEP研究中接受安慰剂者的每100人年0.7例。发病率在1996年达到峰值，为每100人年12.1例，并在2005 - 2012年期间降至每100人年<1例。从队列研究到PrEP研究，注射毒品和共用针头的报告也有所减少（p<0.0001）。在队列研究和疫苗试验期间，海洛因是最常注射的毒品，但在PrEP研究期间，兴奋剂（如甲基苯丙胺）和镇静剂（如咪达唑仑）的注射更为频繁。
2005 - 2012年期间，注射毒品者中的艾滋病毒发病率有所下降。多种因素可能导致了这一下降，包括注射和共用频率的降低、艾滋病毒检测和抗逆转录病毒治疗的可及性提高以及PrEP的使用。扩大有效艾滋病毒预防工具的可及性能够加速控制注射毒品者中的艾滋病毒疫情。
曼谷市政府和美国疾病控制与预防中心，艾滋病毒/艾滋病预防司。
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