Duration Of Injection Drug Use Research Articles

Coinfection with HIV and Hepatitis C Virus among Injection Drug Users in Southern China

We sought to examine coinfection with human immunodeficiency virus (HIV) and hepatitis C virus (HCV) among injection drug users (IDUs) in Guangxi, China. A longitudinal cohort of IDUs (547 subjects) was established to study risk factors for bloodborne infections. At each visit, participants completed questionnaires defining demographic characteristics, patterns of drug use, and sexual behaviors. Blood samples were collected and analyzed for the presence and genotype of HIV and HCV. Coinfection with HIV and HCV was found in 17.6% of the IDUs. HCV was present in 95.1% of HIV-positive and 70.4% of HIV-negative heroin users. The prevalence of HIV in HCV-positive and HCV-negative heroin users was 23.4% and 3.6%, respectively. Multivariate logistic regression analysis revealed that sexual activity during the past 6 months and duration of injection drug use were significantly associated with coinfection with HIV and HCV. The main circulating HCV genotypes included 6a (38%), 3b (37%), and 1a (19%), whereas genotypes 6e (4%), 3a (2%), and 1b (1%) were present in only a few IDUs. Multiple HCV genotypes were present at each study site and did not segregate by HIV status or subtype. HCV is highly prevalent in IDUs throughout southern China. In Guangxi, HIV infections are the result of parenteral and sexual transmission, and, therefore, all IDUs are at high risk of coinfection with HIV and HCV. Molecular tracking of HCV may be a more sensitive predictor of the future spread of the HIV-1 epidemic than is HIV subtyping. This study emphasizes that, without implementation of injection prevention and primary substance abuse programs in China, the extent and effect of coinfection with HIV and HCV will only increase.

Trends in human immunodeficiency virus infection among drug users in a detoxification unit.

In a cross-sectional study of 1111 injection drug users (IDUs) admitted to a hospital detoxification unit between 1987 and 2001, characteristics of substance abuse and blood samples were obtained at study entry. The median age at admission was 27 years, the median age at first injection of drugs was 19 years, and the median duration of injection drug use was 84 months. Overall prevalence of human immunodeficiency virus (HIV) infection was 60% (58% in men, 66% in women; P=.026). Age at start of and duration of injection drug use were associated with HIV infection (P<.001). The rate of HIV infection in persons with short duration of drug use (<24 months) was higher among women (45%) than among men (21%) (P=.002). The prevalence of HIV infection among IDUs <21 years old at first use of injection drugs and among patients reporting <48 months of injection drug use was significantly lower in those who started injection drug use after 1992 (19% vs. 53% of IDUs; odds ratio, 4.42; 95% confidence interval, 1.80-10.85). Awareness of acquired immunodeficiency syndrome, preventive measures, and substance abuse treatment have contributed to the stabilization of the HIV epidemic. The higher prevalence of HIV infection among women IDUs and among young IDUs who recently began injecting drugs emphasizes the need to target HIV-transmission risk reduction interventions early.

Sources of injecting equipment for drug users in Moscow, Russia

Syringe exchange programmes (SEPs) were approved in Moscow in 2002 and studies to evaluate access to sterile syringes are now needed. Clients of a non-governmental organisation (NGO) providing outreach to IDUs were interviewed concerning behaviours within the previous 30 days. Of 232 IDUs, 64% were male, mean age was 25 and mean duration of injection drug use was 5.8 years. Twelve percent reported injecting with used syringes and using prefilled syringes; 6% passed syringes to others and 91% shared paraphernalia. Seventy nine per cent admitted that they had never had a sterile syringe every time they needed it. Among women, 45% used pharmacies as their only source of injecting equipment. Out of 10 potential syringe sources, pharmacies were the major source, especially for women. The other two major sources were other drug users and drug dealers. NGOs offering syringe exchange were mentioned by 9%, whereas medical institutions were reported as the least popular source. Almost all (99%) reported that syringes are not expensive and their procurement is not difficult, but 83% mentioned that buying syringes at pharmacies often involves a risk of being examined by law enforcement staff. These results indicate that significant barriers for procurement and use of sterile syringes exist in Moscow.

Prevalence of SEN viruses among injection drug users in the San Francisco Bay area.

SEN viruses (SENVs) are newly discovered bloodborne viruses that may play a role in liver disease. SENV strain prevalence was examined in a race/ethnicity-stratified sample of 531 injection drug users (IDUs) from the San Francisco Bay area. Weighted prevalences were as follows: SENV-A, 45.7%; SENV-C/H, 35.6%; and SENV-D, 10.3%. Infection was associated with a longer duration of injection drug use. SENV-A was more common in black subjects (adjusted odds ratio [OR(a)], 4.37; 95% confidence interval [CI], 2.65-7.21) and Hispanic subjects (OR(a), 2.30; 95% CI, 1.38-3.85) than in white and non-Hispanic subjects, and the pattern was similar for SENV-C/H. For SENV-D, prevalence was similar in black and white subjects, but lower in Hispanic subjects; infection was less common among women than men (OR(a), 0.32; 95% CI, 0.15-0.71) and more common among men with at least 1 recent male sex partner than among heterosexual men (OR(a), 7.05; 95% CI, 2.62-18.95). SENV strains are common among San Francisco Bay area IDUs, and prevalence varies demographically within this group.

Seroprevalence of human herpesvirus 8 among injection drug users in San Francisco.

The association between injection drug use and human herpesvirus 8 (HHV-8) was examined to investigate bloodborne transmission of the virus. In all, 1905 injection drug users (IDUs) enrolled in a cross-sectional study were tested for K8.1 antibodies to HHV-8 lytic antigen. Logistic regression was used to adjust for demographic and sexual behavior variables. HHV-8 seroprevalence was 10% among women, 10% among heterosexual men, and 23% among men who have sex with men. In adjusted analyses, HHV-8 seroprevalence increased with longer duration of injection drug use for each of these groups (P = .01, P = .03, and P = .049 for trend, respectively). HHV-8 infection is relatively common among IDUs in San Francisco, and longer duration of injection drug use is associated with an increase in the risk of HHV-8 infection that is not explained by sexual behavior or demographic differences. These results are consistent with the occurrence of bloodborne transmission of HHV-8 among IDUs.

High prevalence of abscesses and cellulitis among community-recruited injection drug users in San Francisco.

The prevalence of and risk factors for abscesses and cellulitis were investigated among a community sample of injection drug users (IDUs). Participants were interviewed, and those with symptoms were examined. Of 169 IDUs, 54 (32%) had abscesses (n=35), cellulitis (n=5), or both (n=14); 27% had lanced their own abscesses; and 16% had self-treated with antibiotics they purchased on the street. IDUs who skin-popped (injected subcutaneously or intramuscularly) were more likely to have an abscess or cellulitis than those who had injected only intravenously (odds ratio, 4.9; 95% confidence interval, 2.2-11). The likelihood of abscesses and cellulitis increased with frequency of skin-popping and decreased with increasing duration of injection drug use. Abscesses are extremely prevalent among IDUs in San Francisco. Skin-popping is a major risk factor, and self-treatment is common.