Des Jarlais D C, Friedman S R, Sotheran J L, Wenston J, Marmor M, Yancovitz S R, Frank B, Beatrice S, Mildvan D
Beth Israel Medical Center, National Development and Research Institutes Inc, New York, NY 10013.
JAMA. 1994 Jan 12;271(2):121-7.
To examine trends in acquired immunodeficiency syndrome (AIDS) risk behavior and human immunodeficiency virus (HIV) seroprevalence among injecting drug users (IDUs) in New York City from 1984 through 1992.
Comparisons were made between two surveys of IDUs at the same hospital-based New York City drug abuse detoxification program: 141 IDUs in 1984 and 974 IDUs in 1990 through 1992. National Death Registry, New York City Health Department, and drug treatment program records were also used.
Persons attending detoxification program randomly selected for participation. Eligibility was based on injection within previous 2 months; 99% acceptance rates were obtained. Participants in the 1984 and 1990 through 1992 surveys were 66% and 79% men, 21% and 19% white, 33% and 34% African American, and 45% and 46% Latin American, respectively.
Community-based AIDS prevention programs, including underground syringe exchanges.
Acquired immunodeficiency syndrome risk behaviors; HIV serostatus; CD4+ cell counts; death rates among 1984 subjects; and injection and intranasal routes of drug administration.
The HIV seroprevalence remained stable at slightly more than 50%. Mean CD4+ cell counts declined from 0.716 x 10(9)/L (716/microL) to 0.575 x 10(9)/L (P < .009). Annual death rate among 1984 subjects was 3%, with a significantly higher rate among HIV-seropositive subjects (relative risk, 2.57; 95% exact binomial confidence interval, 1.12 to 6.61). Large-scale declines were observed in AIDS risk behaviors, eg, use of potentially contaminated syringes declined from 51% to 7% of injections (P < .001). Recent additional risk reduction was associated with use of the underground syringe exchanges. Intranasal heroin use was the primary route of drug administration for 46% of heroin admissions to New York City drug treatment programs.
The HIV seroprevalence has remained stable among this population of New York City IDUs for almost a decade. Continuation of current trends should lead to further reduction in HIV transmission, although reversal of the trend to intranasal use could lead to substantially increased transmission.
研究1984年至1992年纽约市注射吸毒者（IDU）中获得性免疫缺陷综合征（AIDS）风险行为及人类免疫缺陷病毒（HIV）血清阳性率的变化趋势。
在纽约市同一家以医院为基础的药物滥用戒毒项目中，对两组IDU调查结果进行比较：1984年的141名IDU和1990年至1992年的974名IDU。还使用了国家死亡登记处、纽约市卫生部门及药物治疗项目记录。
随机选取参加戒毒项目的人员。入选条件为前2个月内有注射行为；接受率达99%。1984年及1990年至1992年调查的参与者中男性分别占66%和79%，白人分别占21%和19%，非裔美国人分别占33%和34%，拉丁裔分别占45%和46%。
以社区为基础的艾滋病预防项目，包括地下针头交换。
获得性免疫缺陷综合征风险行为；HIV血清学状态；CD4 +细胞计数；1984年研究对象的死亡率；药物注射及鼻内给药途径。
HIV血清阳性率保持稳定，略高于50%。CD4 +细胞平均计数从0.716×10⁹/L（716/μL）降至0.575×10⁹/L（P <.009）。1984年研究对象的年死亡率为3%，HIV血清阳性者死亡率显著更高（相对危险度，2.57；95%确切二项式置信区间，1.12至6.61）。艾滋病风险行为大幅下降，例如，使用可能受污染注射器的注射行为从51%降至7%（P <.001）。近期额外的风险降低与使用地下针头交换有关。在纽约市药物治疗项目收治的海洛因使用者中，46%的人主要通过鼻内途径使用海洛因。
近十年来，纽约市这群IDU的HIV血清阳性率一直保持稳定。若当前趋势持续，HIV传播应会进一步减少，不过鼻内用药趋势逆转可能导致传播大幅增加。
