van Ameijden E J, Coutinho R A
Municipal Health Service, Division of Public Health and Environment, Amsterdam, The Netherlands.
AIDS. 1998 Apr 16;12(6):625-33. doi: 10.1097/00002030-199806000-00012.
To examine whether the decrease in HIV incidence and injecting risk behaviours is ongoing in Amsterdam, and to study the determinants of injecting risk behaviours.
Prospective open cohort study (1986-1997) amongst injecting drug users (IDU).
HIV incidence was studied using Poisson regression analysis. Trends in injecting risk behaviours were determined using 6645 visits of 879 participants, stratified by HIV serostatus and number of the follow-up visit. Generalized estimating equations were used to account for repeated measurements, and additive model structures were used.
A large initial risk reduction (1986-1991) occurred concerning borrowing and lending of used needles, multiple needle use and frequent injecting. However, except for frequent injecting, the rate of behaviour change significantly decreased, and from 1991-1993 onwards there was no substantial further risk reduction. HIV incidence followed a similar pattern. Injecting risk was much lower at follow-up visits. The following determinants of borrowing and lending among both HIV-positive and negative IDU were largely comparable: young age, non-injecting heroin and cocaine use, frequent tranquillizer use, multiple needle use, injecting with others, and irregular use of needle-exchange programmes.
The observed residual risk, given the extensive HIV prevention measures in Amsterdam, indicates that further prevention is difficult. Because this risk was associated with an HIV incidence of 3-4% per year, HIV prevalence is likely to be high for many years. Therefore, prevention measures should be maintained because of the possibility of behavioural relapse associated with recent availability of potent HIV treatments. To prevent an HIV epidemic amongst a new generation of drug users, prevention of injecting itself is warranted.
研究阿姆斯特丹的艾滋病毒发病率和注射风险行为的下降趋势是否仍在持续，并探究注射风险行为的决定因素。
对注射吸毒者进行前瞻性开放队列研究（1986 - 1997年）。
采用泊松回归分析研究艾滋病毒发病率。利用879名参与者的6645次就诊情况确定注射风险行为的趋势，按艾滋病毒血清学状态和随访次数分层。使用广义估计方程来处理重复测量，并采用加法模型结构。
在借用和共用用过的针头、多次使用针头以及频繁注射方面，最初出现了大幅风险降低（1986 - 1991年）。然而，除了频繁注射外，行为改变率显著下降，从1991 - 1993年起，风险没有进一步大幅降低。艾滋病毒发病率呈现类似模式。随访时注射风险要低得多。艾滋病毒阳性和阴性注射吸毒者在借用和共用针头方面的以下决定因素在很大程度上具有可比性：年轻、不注射海洛因和可卡因、频繁使用镇静剂、多次使用针头、与他人一起注射以及不定期使用针头交换项目。
鉴于阿姆斯特丹采取了广泛的艾滋病毒预防措施，观察到的残余风险表明进一步预防存在困难。由于这种风险与每年3 - 4%的艾滋病毒发病率相关，艾滋病毒流行率可能在许多年内居高不下。因此，鉴于近期强效艾滋病毒治疗药物的出现可能导致行为复发，应维持预防措施。为防止新一代吸毒者中出现艾滋病毒流行，有必要预防注射行为本身。
