Fennema J S, Van Ameijden E J, Van Den Hoek A, Coutinho R A
Municipal Health Service, Department of Public Health and Environment, Amsterdam, The Netherlands.
Addiction. 1997 Nov;92(11):1457-65.
To determine whether young or recent-onset injecting drug users (IDUs) are at increased risk of HIV infection, and to compare trends in risk behaviours and HIV incidence among subgroups of IDUs.
Associations of age and onset of injecting with HIV prevalence and injecting risk behaviours were determined among current IDUs who entered an Amsterdam cohort between 1989 and 1995, and compared with current IDUs recruited in two street surveys in 1990 and 1993. In the cohort, trends from 1986 through 1995 in injecting risk behaviour (as reported at entry) and in HIV seroconversion (among current IDUs during follow-up) were determined using logistic and Poisson regression.
Sizable portions of IDUs were young (< or = 25 years: 14-30%) or had recently started injecting (within the last 3 years: 17-21%). Between 37% and 50% of young IDUs recently started injecting. HIV prevalence was 12-24% among young IDUs, and 5-12% among recent-onset IDUs. Young IDUs more often reported current borrowing than older IDUs. Borrowing declined significantly in all subgroups, except young IDUs. The crude HIV incidence declined from 18/100 person-years (PY) in 1986 to 5/100 PY in 1995. Trends in HIV incidence were not significantly different for subgroups of age or onset of injecting. In a multivariate analysis, recent onset of injecting was an independent predictor (p = 0.04) for HIV seroconversion, but age was not (p = 0.68).
Important proportions of drug users are young or have recently started injecting. HIV prevalence is relatively high among young and recent-onset IDUs. Recent onset of injection is an independent predictor for HIV seroconversion. Our observations may be explained by non-random patterns of borrowing used needles/syringes. Recent-onset IDUs should be approached more actively for HIV counselling and testing.
确定年轻或近期开始注射毒品的使用者（注射吸毒者）感染艾滋病毒的风险是否增加，并比较注射吸毒者亚组中风险行为和艾滋病毒发病率的趋势。
在1989年至1995年间进入阿姆斯特丹队列的现注射吸毒者中，确定年龄和开始注射与艾滋病毒流行率及注射风险行为之间的关联，并与1990年和1993年两次街头调查中招募的现注射吸毒者进行比较。在该队列中，使用逻辑回归和泊松回归确定了1986年至1995年期间注射风险行为（如入组时报告）和艾滋病毒血清转化（随访期间现注射吸毒者中）的趋势。
相当一部分注射吸毒者年龄较小（≤25岁：14 - 30%）或最近开始注射（过去3年内：17 - 21%）。37%至50%的年轻注射吸毒者最近开始注射。年轻注射吸毒者的艾滋病毒流行率为12 - 24%，近期开始注射的吸毒者为5 - 12%。年轻注射吸毒者比年长注射吸毒者更常报告当前借用行为。除年轻注射吸毒者外，所有亚组的借用行为均显著下降。艾滋病毒粗发病率从1986年的18/100人年降至1995年的5/100人年。年龄或开始注射亚组的艾滋病毒发病率趋势无显著差异。在多变量分析中，最近开始注射是艾滋病毒血清转化的独立预测因素（p = 0.04），但年龄不是（p = 0.68）。
重要比例的吸毒者年龄较小或最近开始注射。年轻和近期开始注射的注射吸毒者中艾滋病毒流行率相对较高。最近开始注射是艾滋病毒血清转化的独立预测因素。我们的观察结果可能由借用用过的针头/注射器的非随机模式来解释。应更积极地为近期开始注射的注射吸毒者提供艾滋病毒咨询和检测。
