Metzger D S, Woody G E, McLellan A T, O'Brien C P, Druley P, Navaline H, DePhilippis D, Stolley P, Abrutyn E
University of Pennsylvania/VA Center for Studies of Addiction, Philadelphia 19104.
J Acquir Immune Defic Syndr (1988). 1993 Sep;6(9):1049-56.
Our objective was to determine the prevalence and incidence of human immunodeficiency virus (HIV) infection and related risk behaviors among opiate-abusing intravenous drug users (IVDUs) either in or out of methadone treatment. The subjects, 152 in-treatment and 103 out-of-treatment intravenous opiate users, were followed prospectively for 18 months. Behavioral and serologic assessments were made at 6-month intervals, with complete information available on 89% of the sample. Subjects were recruited from a single methadone maintenance program and the surrounding neighborhood in north-central Philadelphia. At baseline, the HIV seroprevalence rate for the total sample was 12%: 10% for the methadone-maintained group and 16% for the out-of-treatment group. Out-of-treatment subjects were injecting drugs, sharing needles, visiting shooting galleries, and practicing unsafe sex at significantly higher rates than in-treatment subjects. Follow-up of HIV-negative subjects over the next 18 months showed conversion rates of 3.5% for those who remained in methadone maintenance versus 22% for those who remained out of treatment. The sixfold difference in rate of seroconversion between the two groups suggests that although rapid transmission of HIV still occurs, opiate-abusing IVDUs who enter methadone treatment are significantly less likely to become infected. In contrast, those opiate addicts who do not enter treatment are at significantly higher risk of contracting and spreading the disease. Implications for developing additional risk interventions for out-of-treatment IVDUs are discussed.
我们的目标是确定接受或未接受美沙酮治疗的阿片类药物滥用静脉注射吸毒者（IVDUs）中人类免疫缺陷病毒（HIV）感染的患病率和发病率以及相关风险行为。对152名正在接受治疗和103名未接受治疗的静脉注射阿片类药物使用者进行了为期18个月的前瞻性随访。每6个月进行一次行为和血清学评估，89%的样本可获得完整信息。研究对象从费城北部中心的一个单一美沙酮维持治疗项目及周边社区招募。基线时，总样本的HIV血清阳性率为12%：美沙酮维持治疗组为10%，未接受治疗组为16%。未接受治疗的研究对象在注射毒品、共用针头、光顾射击馆和进行不安全性行为方面的发生率显著高于接受治疗的研究对象。在接下来的18个月里，对HIV阴性研究对象的随访显示，继续接受美沙酮维持治疗的研究对象的血清转化率为3.5%，而未接受治疗的研究对象的血清转化率为22%。两组血清转化率相差6倍，这表明尽管HIV仍在快速传播，但接受美沙酮治疗的阿片类药物滥用IVDUs感染的可能性显著降低。相比之下，那些未接受治疗的阿片类成瘾者感染和传播该疾病的风险显著更高。本文讨论了为未接受治疗的IVDUs制定额外风险干预措施的意义。
