Alcabes P, Friedland G
Yale University AIDS Program, New Haven, Connecticut 06510, USA.
Clin Infect Dis. 1995 Jun;20(6):1467-79. doi: 10.1093/clinids/20.6.1467.
In this paper we discuss the epidemiology and natural history of human immunodeficiency virus (HIV) infection in users of injection drugs. Use of injection drugs plays a central role in the HIV infection/AIDS epidemic in the United States, Europe, and many parts of the developing world. The significance of this role has been underappreciated until quite recently because of a number of factors. One factor has been systematic, albeit inadvertent, underreporting of cases of HIV disease and AIDS in drug injectors as a consequence of the initially narrow surveillance case definition for AIDS. A measure of this phenomenon has been the disproportionately larger increment of new cases in this population with each successive revision of the Centers for Disease Control and Prevention's surveillance case definition for AIDS. Other reasons for the underappreciation of the magnitude and consequences of HIV infection and AIDS in injection drug users include the lack of necessary diagnostic facilities in the institutions where drug users are often treated, high mortality rates among HIV-infected drug users for whom a diagnosis of AIDS has not yet been made, the severe marginalization of this population and its lack of advocates, and the localization of the initial epidemic in this population to certain geographic areas.
在本文中，我们讨论了注射吸毒者中人类免疫缺陷病毒（HIV）感染的流行病学和自然史。在美国、欧洲以及发展中世界的许多地区，注射吸毒在HIV感染/艾滋病流行中起着核心作用。由于多种因素，直到最近这一作用的重要性才得到充分认识。一个因素是，由于最初对艾滋病监测病例定义较窄，导致对吸毒者中HIV疾病和艾滋病病例的系统性漏报，尽管这种漏报并非故意。这一现象的一个表现是，随着美国疾病控制与预防中心对艾滋病监测病例定义的每次相继修订，该人群中新病例的增加幅度 disproportionately larger 。对注射吸毒者中HIV感染和艾滋病的严重程度及后果认识不足的其他原因包括，吸毒者经常接受治疗的机构缺乏必要的诊断设施，尚未被诊断为艾滋病的HIV感染吸毒者死亡率高，这一人群严重边缘化且缺乏倡导者，以及该人群中最初的疫情局限于某些地理区域。
