Fisher D G, Fenaughty A M, Trubatch B
University of Alaska, Anchorage 99508, USA.
J Psychoactive Drugs. 1998 Jul-Sep;30(3):299-305. doi: 10.1080/02791072.1998.10399705.
Many risk factors for HIV incidence among drug users have been reported in the literature. However most of these studies have been with local samples, and typically have had limited sample sizes. The National Institute on Drug Abuse (NIDA) funded a Cooperative Agreement for AIDS Community-Based Outreach/Intervention Research (CA) since 1991 that produced a national database. Associations found in the literature were tested to determine whether they were replicated on this national database. The CA national database had complete data, including blood draws six months apart, on 6,970 drug users who were seronegative at baseline. Sites that had no seroincident cases were excluded from the analysis. Twenty-nine risk factors identified in the literature were tested on the national database on a bivariate basis. There were 56 seroincident cases (those who were HIV-seronegative at baseline and HIV-seropositive at follow-up) out of 3752 person years at risk, for a seroconversion rate of 1.49 (CI 1.05, 1.94) per 100 person years at risk. Data were analyzed both as a whole dataset and with the sites stratified by high and low prevalence. In the overall analysis, risk factors associated with seroconversion were times injected any drug, ever injected any drug, days injected cocaine, times injected cocaine, and times injected speedball (these variables had a 30-day time referent). Also significant was how recently formerly-used injection equipment was used. High-prevalence sites revealed associations for times injected any drug, days injected cocaine, and times injected speedball. Low-prevalence sites revealed associations for injected any drug and days injected cocaine. These findings highlight the importance of injection drug use, especially cocaine injection, as a major risk factor in recent seroconversion.
文献中已报道了许多吸毒者感染艾滋病毒的风险因素。然而，这些研究大多采用的是当地样本，而且样本量通常有限。自1991年以来，美国国家药物滥用研究所（NIDA）资助了一项艾滋病社区外展/干预研究合作协议（CA），该协议建立了一个全国性数据库。对文献中发现的关联进行了测试，以确定它们是否能在这个全国性数据库中得到重现。CA全国性数据库拥有完整的数据，包括对6970名在基线时血清学呈阴性的吸毒者每隔六个月进行的血液检测。没有血清学发病病例的地点被排除在分析之外。在全国性数据库中，对文献中确定的29个风险因素进行了双变量测试。在3752人年的风险期内，有56例血清学发病病例（那些在基线时艾滋病毒血清学呈阴性而在随访时呈阳性的人），血清转化率为每100人年风险期1.49（置信区间1.05，1.94）。数据作为一个整体数据集进行了分析，也按高流行率和低流行率对各地点进行了分层分析。在总体分析中，与血清转化相关的风险因素有注射任何药物的次数、曾注射任何药物、注射可卡因的天数、注射可卡因的次数以及注射速球的次数（这些变量以30天为时间参考）。最近使用以前用过的注射设备的时间也具有显著性。高流行率地点显示出注射任何药物的次数、注射可卡因的天数和注射速球的次数之间存在关联。低流行率地点显示出注射任何药物和注射可卡因的天数之间存在关联。这些发现凸显了注射吸毒，尤其是可卡因注射，作为近期血清转化的一个主要风险因素的重要性。
