Des Jarlais D C, Marmor M, Paone D, Titus S, Shi Q, Perlis T, Jose B, Friedman S R
Beth Israel Medical Center, Chemical Dependency Institute, New York, NY 10003, USA.
Lancet. 1996 Oct 12;348(9033):987-91. doi: 10.1016/s0140-6736(96)02536-6.
There have been no studies showing that participation in programmes which provide legal access to drug-injection equipment leads to individual-level protection against incident HIV infection. We have compared HIV incidence among injecting drug users participating in syringe-exchange programmes in New York City with that among non-participants.
We used meta-analytic techniques to combine HIV incidence data from injecting drug users in three studies: the Syringe Exchange Evaluation (n = 280), in which multiple interviews and saliva samples were collected from participants at exchange sites; the Vaccine Preparedness initiative cohort (n = 133 continuing exchanges and 188 non-exchangers, in which participants were interviewed and tested for HIV every 3 months; and very-high-seroprevalence cities in the National AIDS Demonstration Research (NADR) programme (n = 1029), in which street-recruited individuals were interviewed and tested for HIV every 6 months. In practice, participants in the NADR study had not used syringe exchanges.
HIV incidence among continuing exchange-users in the Syringe Exchange Evaluation was 1.58 per 100 person-years at risk (95% CI 0.54, 4.65) and among continuing exchange-users in the Vaccine Preparedness Initiative it was 1.38 per 100 person-years at risk (0.23, 4.57). Incidence among non-users of the exchange in the Vaccine Preparedness Initiative was 5.26 per 100 person-years at risk (2.41, 11.49), and in the NADR cities, 6.23 per 100 person-years at risk (4.4, 8.6). In a pooled-data, multivariate proportional-hazards analysis, not using the exchanges was associated with a hazard ratio of 3.35 (95% CI 1.29, 8.65) for incident HIV infection compared with using the exchanges.
We observed an individual-level protective effect against HIV infection associated with participation in a syringe-exchange programme. Sterile injection equipment should be legally provided to reduce the risk of HIV infection in persons who inject illicit drugs.
尚无研究表明参与能合法获取注射吸毒器具的项目可使个体获得预防HIV新发感染的保护。我们比较了纽约市参与注射器交换项目的注射吸毒者与未参与者的HIV发病率。
我们运用荟萃分析技术，合并了三项研究中注射吸毒者的HIV发病率数据：注射器交换评估（n = 280），在该研究中，于交换地点从参与者处收集多次访谈资料和唾液样本；疫苗准备计划队列（n = 133名持续交换者和188名非交换者，在该队列中，每3个月对参与者进行访谈并检测HIV）；以及国家艾滋病示范研究（NADR）项目中的高血清流行率城市（n = 1029），在该项目中，每6个月对街头招募的个体进行访谈并检测HIV。实际上，NADR研究中的参与者未使用注射器交换服务。
在注射器交换评估中，持续使用交换服务者的HIV发病率为每100人年1.58例（95%可信区间0.54，4.65），在疫苗准备计划中，持续使用交换服务者的发病率为每100人年每1.38例（0.23，4.57）。在疫苗准备计划中，未使用交换服务者的发病率为每100人年5.26例（2.41，11.49），在NADR城市中为每100人年6.23例（4.4，8.6）。在汇总数据的多变量比例风险分析中，与使用交换服务相比，未使用交换服务与HIV新发感染的风险比为3.35（95%可信区间1.29，8.65）。
我们观察到参与注射器交换项目与个体层面预防HIV感染的保护作用相关。应合法提供无菌注射器具，以降低注射非法药物者感染HIV的风险。
