Non-injection Users Research Articles

HIV Treatment for Alcohol and Non-Injection Drug Users in El Salvador.

Since the mid-1990 s, many developing countries have introduced and expanded the availability of combination antiretroviral therapy (cART) to persons living with HIV (PLH). However, AIDS-related mortality continues to be high particularly among drug users. In this article, we present results from in-depth interviews with 13 HIV medical providers and 29 crack cocaine and alcohol using PLH in El Salvador. Providers endorsed negative attitudes toward substance using PLH and warned PLH that combining cART with drugs and alcohol would damage their livers and kidneys resulting in death. Upon diagnosis, PLH received little information about HIV treatment and many suffered depression and escalated their drug use. PLH reported suspending cART when they drank or used drugs because of providers' warnings. Substance using PLH were given few strategies and resources to quit using drugs. Messages from medical providers discourage drug users from initiating or adhering to antiretroviral therapy (ART) and may contribute to treatment abandonment.

Seroprevalence of Hepatitits B, Hepatitits C, HIV and Syphilis infections among non-injecting drug users

Objective: While injection drug use is clearly a significant risk factor for the acquisition of certain infectious diseases, non-injection drug users (NIDUs) may also have higher risk than the general population, due to their involvement in risky behaviors. This study aimed to examine the prevalence of anti-HIV, anti-HCV, and HBsAg and VDRL seropositivity among a sample of non-injecting drug users. Methods: Medical records of the drug users who attended to our psychiatry clinics between April 2010 and April 2011 were reviewed and 55 non-injecting drug users without a previous history of intravenous drug use were identified. Anti-HIV, anti-HCV, HBs-Ag and VDRL assay results have been extracted and seroprevalence rates were calculated. Results: All but one NIDUs were male (n=54; 98. 2%); 28 (50.9%) were between 15 and 25 years of age. Serologically, only one patient (a heroin user) was tested positive for HBsAg (1.81%) and one patient (a heroin user) was anti-HCV positive. None of the patients screened for anti-HIV or VDRL were tested positive. Conclusions: This study found low seropositivity rates for HBV, HBC, HIV and VDRL among a group of NIDUs, which might be related to the cultural characteristics of the region.

Community Mobilization to Reduce Drug Use, Quang Ninh, Vietnam.

Objectives. We implemented an intervention to reduce drug use in an urban commune in northern Vietnam. Methods. We encouraged the intervention commune to accept responsibility for developing their own intervention strategies based on a community mobilization model used in southern, rural China. We selected a comparison commune, which had demographic characteristics and a drug history similar to the intervention commune. The 2-year incidence of new drug users was estimated retrospectively in the intervention and comparison communes between baseline (2003) and follow-up (2009). Results. Increased incidence of new (noninjecting) drug users between 2003 and 2009 in the intervention commune was lower than that in the comparison commune, and these participants expressed more positive attitudes toward local authority and people with drug use and HIV/AIDS. Increased condom use during last intercourse with female sex workers and with female casual partners was observed in the intervention commune. HIV prevalence and positive opioid tests decreased more in the intervention commune. Conclusions. Our results suggested that the community mobilization had a positive influence in the intervention commune.

Hepatitis C virus (HCV) infection & risk factors for HCV positivity in injecting & non-injecting drug users attending a de-addiction centre in northern India.

Background & objectives:Injecting drug use is a major route of hepatitis C virus (HCV) infection in India, but there may be other risk factors also. This study was carried out to determine the seroprevalence of anti-HCV antibody in injecting drug users (IDUs) vs. non-IDUs (NIDUs), and to study the risk estimates for HCV seropositivity in the total sample of substance users with regard to various demographic, clinical, behavioural and personality factors.Methods:The IDUs (n = 201) and NIDUs (n = 219) were assessed for demographic, clinical and behavioural information, and were rated on instruments for severity of dependence, risk behaviour and personality profiles. Anti-HCV antibody was tested by ELISA and confirmed by recombinant immunoblot assay (RIBA) test.Results:Almost one-third of the IDUs (64 of 201; 31.8%) were positive for anti-HCV antibody, as opposed to only seven (3.2%) of the NIDUs. The four risk factors strongly associated with HCV positivity in multivariate analysis were sharing syringe [Exp(B) 75.04; 95%CI 18.28-307.96; P<0.001], reuse of injection accessories (16.39; 3.51-76.92; P<0.001), blood transfusion (5.88; 1.63-21.23; P=0.007) and IDU status (3.60; 1.26-10.31; P=0.017). Other variables less strongly but significantly associated with HCV positivity were multiple sex partners, opioid dependence, risk behaviour scores, impulsivity, and lower age of onset of drug use.Interpretation & conclusions:Our study showed a high seroprevalence of anti-HCV antibody in IDUs. In the substance users, HCV positivity was significantly and independently associated with several clinical, behavioural, and personality risk factors.

Hepatitis C vaccine clinical trials among people who use drugs: potential for participation and involvement in recruitment

Candidate prophylactic HCV vaccines are approaching phase III clinical trial readiness, yet little is known about the potential for participation among target groups or innovative ways to promote enrollment within ‘hard-to-reach’ populations. This study describes HCV vaccine trial participation willingness among a high-risk sample of people who use drugs and their willingness to assist researchers by promoting the trial among peers. Willingness to participate in and encourage peers' participation in an HCV vaccine trial was assessed among injection and non-injection drug users enrolled in a cohort study in Kentucky using interviewer-administered questionnaires (n=165 and 415, respectively, with willingness to participate assessed among HCV-seronegative participants only). Generalized linear mixed models were used to determine correlates to being “very likely” to participate or encourage participation in a trial. Most reported being likely to participate or encourage participation in a vaccine trial (63% and 87%, respectively). Men were significantly less likely to report willingness to encourage others' participation, while willingness to encourage was higher among lower income, HCV-seropositive, heroin-using, and methamphetamine-using participants. Unemployment, lesser education, receipt of financial support from more peers, and nonmedical prescription drug use were positively associated with willingness to participate. Differential enrollment in HCV vaccine clinical trials by socioeconomic status may occur, underscoring ethical considerations and need for avoiding coercion. Notably, the data suggest that a peer-driven approach to promoting trial participation among people who use drugs could be feasible in this population and that HCV-seropositive individuals and women could be especially instrumental in these efforts.

Knowledge about the transmission of HIV and HCV: A comparison between injection drug users and non-injection drug users

Knowledge about the transmission of HIV and HCV: A comparison between injection drug users and non-injection drug users

HIV risk among female sex workers with different patterns of drug use behaviors in Southwest China: a cross-sectional study

Although many researchers found that drug use behaviors significantly increased HIV risk, few of them investigated the association between HIV risk and different drug use behaviors among female sex workers (FSWs) in China. The current study examines demographic and behavioral risk factors as well as the infections of HIV, syphilis, and among a subgroup of FSWs who are injection drug users (IDU) or noninjection drug users (NIDU) in comparison to Hepatitis C Virus (HCV) nondrug users (non-DU). We conducted secondary analysis of the 2010 National Sentinel Surveillance (NSS) data from Guangxi China. A self-administered, standard behavioral surveillance survey was completed by a total of 12,622 FSWs recruited from Guangxi, China. The Guangxi 2010 NSS sample included 2.6% NIDU and 0.5% IDU. Compared to non-DU, IDU were more likely to report no condom use in the last sex act (aOR = 3.25, 95%CI = 1.65, 6.40), inconsistent condom use in the past month (aOR = 4.88, 95%CI = 2.66, 8.96), having an HIV testing (aOR = 2.48, 95%CI = 1.34, 4.58), infections of HIV (aOR = 42.60, 95%CI = 9.45, 192.06), syphilis (aOR = 4.13, 95%CI = 1.86, 9.16), and HCV (aOR = 74.54, 95%CI = 30.26, 183.61). NIDU had 2.89 times higher than non-DU to report a history of sexually transmitted disease and 26% less likely to report inconsistent condom use in the past month (p < 0.05). We called for tailored, accessible, and nonjudgmental drug treatments coupled with effective sexual risk reduction interventions to help FSWs with various drug use problems to reduce their vulnerability and susceptibility of HIV risk in China as well as other cultural settings.

More safer sex intervention needed for HIV-positive MSM with higher education level for prevention of sexually transmitted hepatitis C.

IntroductionThe epidemiology of hepatitis C virus (HCV) infections in Chinese HIV-infected men who have sex with men (MSM) remains obscure. More data is required to understand the epidemic and set up preventive strategy.Materials and MethodsBaseline and annual testing of anti-HCV was in place for all HIV-infected MSM in the largest HIV clinic in Hong Kong. Logistic regression was used to compare those with HCV seroconversion (seroconverters) with those remained tested anti-HCV negative (non-seroconverters) to identify factors associated with incident HCV.ResultsFrom 1999 to 2013, 1311 patients were tested for anti-HCV seroconversion, contributing to 6295 patient-years of observation. Fourteen (1.1%) patients seroconverted, with genotype 3 being most commonly detected. The overall incidence rate of HCV infection was 0.22 per 100 patient-years (PY) in the cohort. The incidence rate increased from 0.13 per 100PY before 2002 to 0.19 per 100PY in 2002–2007 and 0.47 per 100PY in 2008–2013. All the seroconverters were Chinese, with median age of anti-HCV seroconversion at 38 years (range: 28–53 years). None of them were injecting drug users. As compared with the non-seroconverters, seroconverters were of higher education level (85.7% vs 50.7% tertiary education or above, OR 5.28, p=0.021) and had prior history of sexually transmitted infection (92.9% vs 60.9%, OR 8.34, p=0.041). More seroconverters were found to have history of syphilis infection (57.1% vs 37.2%, p=0.134) but the difference was not statistically significant. Baseline CD4 count and HIV viral load, proportion on antiretroviral therapy and duration of antiretroviral therapy were not different between two groups.ConclusionsThe incidence of HCV has been increasing among HIV-infected MSM non-injecting drug users in Hong Kong. More education and intervention on safer sex is required to be targeted on those with higher education level.

Seroprevalence of Hepatitis E Virus Among Injection Drug Users and Non-Injection Drug Users in Hamadan, West of Iran

Background: Hepatitis E virus (HEV) infection is a self-limited hepatitis and the most common cause of acute adult hepatitis in Asia. Young adults and middle-aged populations are more likely to be infected than other age groups. Objectives: The aim of this study was to determine the seroprevalence of anti-HEV among injection drug users (IDUs) compared to nonIDUs. Patients and Methods: This was a cross-sectional study performed on 131 IDUs referred to Farshchian Hospital, Hamadan, Iran and 131 nonIDUs selected from healthy visitors between March 2011 and March 2012. Anti-HEV IgG was measured in serum by ELISA method (DiaPro, Milan, Italy). Data including age, gender, education, location and duration of injection drug used were collected using a questionnaire. Results: In this study, the seroprevalence of hepatitis E virus antibody among IDUs group was 6.1%, and 1.5% among non-IDU group (Odds Ratio = 5.48; CI = 1/069-22/84), indicating that injection drug users were almost five and a half times more than non-IDUs at risk of HEV infection (P = 0.053). There was no significant association between seroprevalence of hepatitis E virus and education level (P = 0.46), duration of injection (P = 0.38) and location (P = 0.19). Conclusions: Seroprevalence of hepatitis E virus among IDUs group was higher than non-IDU group, which might be due to possible blood transmission of HEV among IDUs.

Survey of Hepatitis B infection and vaccination status among drug users in Xi'an

To explore seroepidemiological status and vaccine coverage of hepatitis B among drug users in Xi'an. 545 drug users in the Xi'an Compulsory Detoxification Center were asked to answer questionnaire and provide blood sample (3-5 ml) for test of HBsAg, anti-HBc and anti-HBs from March to June 2013. Totally, 545 subjects were surveyed and tested. All of them effectively completed the survey. The positive rates of HBsAg, anti-HBc and anti-HBs were 29.4% (160/545), 60.0% (327/545) and 56.1% (306/545), respectively. Eighty five subjects (15.6%) were negative for all of the three markers. The prevalence of HBsAg and anti-HBc among injection drug users were 40.0% (94/235) and 65.6% (154/235), which was significantly higher than non- injection drug users' (21.6% (52/241), 58.5% (141/241)) and mixed non-injection and injection drug users ((20.3% (14/69), 46.4% (32/69)) (χ(2) = 23.518 and 9.017, respectively, P < 0.05) . The HBsAg positive rate (30.6% (153/500)) of subjects with more than once per day of drug using within one year was significantly higher than those who used drugs for 2-3 times per week (15.6% (7/45)) (χ(2) = 4.51, P < 0.05). Only 11.7% (64/545) of drug users had a clear history of hepatitis B vaccination. The vaccination rate of subjects (3.5% (5/141)) with primary education or below was significantly lower than those with high school (16.3% (45/276)) (χ(2) = 26.61, P < 0.05). The vaccination rate of subjects (7.8% (12/153)) over 45 years old was significantly lower than that of subjects below 30 years old (15.9% (21/132)) and 30-44 years old (11.9% (31/260)) (χ(2) = 30.36, P < 0.05). The vaccinees had a significantly higher positive rate of anti-HBs (73.4% (47/64)) than those who without vaccination (53.8% (259/481)) (χ(2) = 8.81, P = 0.003), but the positive rates of HBsAg (16.7% (11/64)) were lower than those who without vaccination (31.0% (149/481)) (χ(2) = 23.52 and 9.02, respectively;P > 0.05). The HBV infection status among drug users in Xi'an was in serious condition, while a low vaccination rate was also discovered among them.

The continued ageing of people with AIDS in Italy: recent trend from the national AIDS Registry.

Introduction. In industrialized countries, the availability of highly active antiretroviral therapy (HAART) caused a slow but substantial ageing of the AIDS epidemic mainly due to the longer survival of persons with HIV/AIDS which has turned HIV into a manageable, chronic disease. The number of older people with AIDS is growing in many European countries. We described the impact of AIDS among persons aged 50 years or more in Italy and compared the characteristics of these cases with those of persons diagnosed with AIDS at an age younger than 50. Methods. The source of data was the Italian AIDS Registry, from 1982 to 2011. We defined "older" persons those aged 50 years or more, and younger individuals those aged less than 50 years. We built two multivariate logistic regression models: the first one to identify factors associated with being older, and the second one to identify AIDS-defining diseases correlated with being older. Variables with a P value of <0.05 were entered in the model. Results. Of the total AIDS cases, 10.5% were among persons older than 49 years. This proportion progressively increased from 0.0% in 1983 to 26.4% in 2011. Among older cases, the incidence of AIDS was 2.0 per 100 000 residents in 1996, then decreased to 1.4 per 100 000 in 2000 and levelled off around 1 per 100 000 residents until 2011. Compared to younger cases, older cases were more frequently males, Italians, diagnosed with AIDS in recent years, residing in Northern or Central Italy, non-injecting drug users, and late testers. Discussion. These findings stress the need for physicians to consider carefully the possibility of HIV infection among older individuals not to miss the opportunity to deliver prevention messages, offer HIV testing, and make an early diagnosis.

Influence of noninjecting and injecting drug use on mortality, retention in the cohort, and antiretroviral therapy, in participants in the Swiss HIV Cohort Study.

We studied the influence of noninjecting and injecting drug use on mortality, dropout rate, and the course of antiretroviral therapy (ART), in the Swiss HIV Cohort Study (SHCS). Cohort participants, registered prior to April 2007 and with at least one drug use questionnaire completed until May 2013, were categorized according to their self-reported drug use behaviour. The probabilities of death and dropout were separately analysed using multivariable competing risks proportional hazards regression models with mutual correction for the other endpoint. Furthermore, we describe the influence of drug use on the course of ART. A total of 6529 participants (including 31% women) were followed during 31 215 person-years; 5.1% participants died; 10.5% were lost to follow-up. Among persons with homosexual or heterosexual HIV transmission, noninjecting drug use was associated with higher all-cause mortality [subhazard rate (SHR) 1.73; 95% confidence interval (CI) 1.07-2.83], compared with no drug use. Also, mortality was increased among former injecting drug users (IDUs) who reported noninjecting drug use (SHR 2.34; 95% CI 1.49-3.69). Noninjecting drug use was associated with higher dropout rates. The mean proportion of time with suppressed viral replication was 82.2% in all participants, irrespective of ART status, and 91.2% in those on ART. Drug use lowered adherence, and increased rates of ART change and ART interruptions. Virological failure on ART was more frequent in participants who reported concomitant drug injections while on opiate substitution, and in current IDUs, but not among noninjecting drug users. Noninjecting drug use and injecting drug use are modifiable risks for death, and they lower retention in a cohort and complicate ART.

Differences in prevalence of HIV and HCV between blacks and whites based on patterns of injection and non-injection drug users in Baltimore City

s / Drug and Alcohol Dependence 140 (2014) e86–e168 e101 Differences in prevalence of HIV and HCV between blacks and whites based on patterns of injection and non-injection drug users in Baltimore City Larry Keen, W.W. Latimer Clinical and Health Psychology, University of Florida, Gainesville, FL, United States Aims: The current study examineddifferences in the prevalence of viral hepatitis C and HIV disease between Blacks and Whites adults in Baltimore City across three subtypes of drug users identified in previous research (Harrell et al., 2012): crack/nasal heroin users, heroin injectors, and polysubstance users. Methods: This study was a part of an ongoing NIDA-funded NEURO-HIV Epidemiologic study, a longitudinal study to identify neuropsychological and social-behavioral HIV risk factors among injection and non-injection drug users. Results: The subsample of 482 participants included 284 men (58.9%) and 198 women (41.1%). Approximately half of the participants self-identified as White (n=244), while the rest selfidentified as Black (n=238). There were significant differences between classes based on race (X2 (2, N=482) =97.84, p= .00) and HCV (X2 (2, N=482) =140.87, p= .00). Differences indicated that crack/nasal heroin users were predominantly Black (74.9%), while heroin injectors and polysubstance users were predominantly white (71.5% and 68.9%). Polysubstance users accounted for over half of the HCV positive diagnoses (56.5%) in Whites. Blacks HCV diagnoses were somewhat evenly spread across the groups. Though HIV did not differ significantly between groups, the Crack/Nasal Heroin contained over half (52.4%) of the 42 HIV positive diagnoses in the sample. Conclusions: Black drug users in this sample were characterized by significantly lower rates of IDU compared to whites. Since the vastmajority of the current sample is heterosexual, the findings suggest heterosexual sex as the primary mode of HIV transmission for Black drug users. In contrast,White drug usersweremore prone to HCV compared to Black drug users, which is attributable to their higher rate of IDU. The current study findings provide further support that heterosexual transmission of HIV is a primary vector of disease transmission among African American drug users who predominantly do not inject drugs and thereby may help to inform targets of disease prevention. Financial support: NIDA: RO1 DA 14498. http://dx.doi.org/10.1016/j.drugalcdep.2014.02.291 Daysimeter feasibility and acceptability in a polysubstance-using population Ashley Kennedy1, M. Rea2, M. Figueiro2, Michelle L. Jobes1, D. Epstein1, Kenzie L. Preston1 1 National Institute on Drug Abuse, Baltimore, MD, United States 2 Rensselaer Polytechnic Institute, Troy, NY, United

A social network-informed latent class analysis of patterns of substance use, sexual behavior, and mental health: Social Network Study III, Winnipeg, Manitoba, Canada.

We assessed whether a meaningful set of latent risk profiles could be identified in an inner-city population through individual and network characteristics of substance use, sexual behaviors, and mental health status. Data came from 600 participants in Social Network Study III, conducted in 2009 in Winnipeg, Manitoba, Canada. We used latent class analysis (LCA) to identify risk profiles and, with covariates, to identify predictors of class. A 4-class model of risk profiles fit the data best: (1) solitary users reported polydrug use at the individual level, but low probabilities of substance use or concurrent sexual partners with network members; (2) social-all-substance users reported polydrug use at the individual and network levels; (3) social-noninjection drug users reported less likelihood of injection drug and solvent use; (4) low-risk users reported low probabilities across substances. Unstable housing, preadolescent substance use, age, and hepatitis C status predicted risk profiles. Incorporation of social network variables into LCA can distinguish important subgroups with varying patterns of risk behaviors that can lead to sexually transmitted and bloodborne infections.

Epidemiological aspects of HCV infection in non-injecting drug users in the Brazilian state of Pará, eastern Amazon.

BackgroundCurrently, sharing of drug paraphernalia is the main form of HCV transmission worldwide. In South America, consistent findings indicate that shared sniffing equipment is an important factor in the spread of HCV among non-injecting drug users. Epidemiological data on the status of HCV infection in illicit drug users in the Amazon region are scarce, although reports of clinical cases of hepatitis or pathologies associated with HCV infection in other population groups are numerous. Thereby, this study investigated the prevalence, genotype frequency, and epidemiological factors associated with HCV infection in non-injecting drug users in the state of Pará, eastern Amazon.ResultsDuring 2008–2011, 300 non-injecting drug users attending drug-treatment centers participated in this study. Most non-injecting drug users were male (63.7%). The mean age was 32.5 years. The non-injecting drugs most consumed were: cannabis (15.6%), cocaine paste (21.3%), and oxi cocaine (25.7%). Tobacco (60.9%) and alcohol (79.4%) were also commonly consumed. One hundred six (35.1%; CI 95%: 29.8 - 41.1) non-injecting drug users presented anti-HCV antibodies by EIA. The HCV-RNA prevalence was 28.0% (95% CI: 20.6 - 35.8). Genotypes 1 (76.9%) and 3 (23.1%) of HCV have been identified. A multivariate analysis demonstrated that HCV infection was independently associated with the following factors: “age (≥ 35 years)”, “tattoos”, “use of a needle or syringe sterilized at home”, “shared use of drug paraphernalia”, “uses drugs for more than 5 years”, and “use of drugs everyday”.ConclusionsThis study revealed a high prevalence of HCV infection in non-injecting drug users, and most infections are occasioned by genotype 1. Likely, HCV transmission is associated with the tattoos, the use of needle or syringe sterilized at home by people over the age of 35 years, and sharing, time and frequency of use of non-injecting drugs. These findings should serve as an incentive for the establishment of a program of Hepatitis C prevention and control by the local public-health authorities in order to develop effective policies and strategies for contain the spread of HCV infection.

Differences in sociodemographic, drug use and health characteristics between never, former and current injecting, problematic hard-drug users in the Netherlands

BackgroundInjecting drug users are at increased risk for harmful effects compared to non-injecting drug users. Some studies have focused on differences in characteristics between these two groups (e.g., housing, overall health). However, no study has investigated the specific Dutch situation which in the last years has seen a decrease in homelessness among problematic hard-drug users and an increasing focus on physical health in low-threshold addiction care. The purpose of this study was to determine differences in sociodemographic, drug use and health characteristics between never-injecting (NIDUs), former-injecting (FIDUs) and current-injecting drug users (IDUs) and describe injecting practices.MethodsA total of 202 problematic hard-drug users (NIDU = 64; FIDU = 76; IDU = 62) were recruited from 22 low-threshold care facilities, including drug consumption rooms, methadone maintenance treatment, heroin-assisted therapy, day shelter and/or night shelter, supported housing and day activity centres. Data were collected on-site through structured face-to-face interviews.ResultsResults indicate that IDUs represented a separate group of problematic hard-drug users, with distinct sociodemographic and drug use characteristics. Overall, IDUs appeared to be the group with least favourable characteristics (unstable housing/homelessness, illegal activities, polydrug use) and NIDUs appeared to have the most favourable characteristics (stable housing, help with debts, less polydrug use). The FIDU group lies somewhere in between. The three groups did not differ significantly in terms of health. Regarding injecting practices, results showed that majority of IDUs had injected drugs for over 10 years and IDUs injected heroin, cocaine, amphetamine and/or methadone in the past 6 months. Sharing syringes was not common. A quarter reported public injecting.ConclusionsUnstable housing and homelessness are related to (former) injecting drug use, and stable housing is related to never-injecting drug use. Our study suggests that the number of ‘new’ IDUs is low. However, public injecting among IDUs is not uncommon and is associated with unstable housing. This emphasizes the potential of housing projects as a component of harm reduction measures. Therefore, prevention of (risks associated with) injecting drug use and supported housing programmes for problematic hard-drug users deserve the continuous attention of policymakers and professionals in low-threshold addiction care.

A Perfect Storm: Crack Cocaine, HSV-2, and HIV Among Non-Injecting Drug Users in New York City

Prevalence of human immunodeficiency virus (HIV) infection has reached 16% among non-injecting drug users (NIDU) in New York City, an unusually high prevalence for a predominantly heterosexual population that does not inject drugs. Using a long-term study (1983–2011, >7,000 subjects) among persons entering the Beth Israel drug-treatment programs in New York City, we identified factors that contributed to this high prevalence: a preexisting HIV epidemic among injectors, a crack cocaine epidemic, mixing between injectors and crack users, policy responses not centered on public health, and herpes-simplex virus 2 facilitating HIV transmission. Implications for avoiding high prevalence among NIDU in other areas are discussed.

Incidence and Risk Factors for Incident Hepatitis C Infection Among Men Who Have Sex With Men With HIV-1 Infection in a Large Urban HIV Clinic in Tokyo

The epidemiology of hepatitis C virus (HCV) infection among HIV-infected men who have sex with men (MSM) who do not inject drugs in Asia remains unknown. The incidence and risk factors for incident HCV infection among HIV-infected MSM at a large HIV clinic in Tokyo were elucidated. Poisson regression compared the incidence of HCV seroconversion at different observation periods. Of 753 HIV-1 infected MSM patients negative for HCV antibody (HCVAb) at baseline and available follow-up HCVAb test, 21 patients (2.8%) seroconverted to HCVAb positive over 2246 person-years (PY), for an incidence of 9.35 per 1000 PY. The incidence increased over time from 0 per 1000 PY in 2005-2006, 3.0 per 1000 PY in 2007-2008, 7.7 per 1000 PY in 2009-2010, to 24.9 per 1000 PY in 2011-2012 (P = 0.012). Of 21 incident cases, only 4 (19%) were injection drug users, and sensitivity analysis that excluded injection drug users yielded similar findings. Multivariate analysis identified illicit drug use to be an independent risk for HCV infection (hazard ratio = 3.006; 95% confidence interval: 1.092 to 8.275; P = 0.033). Incident HCV infection is increasing among HIV-1-infected MSM noninjection drug users at resource-rich setting in Asia. Illicit drug use is an independent risk factor for incident HCV infection in this population.

HSV-2 Co-Infection as a Driver of HIV Transmission among Heterosexual Non-Injecting Drug Users in New York City

ObjectiveTo examine herpes simplex virus 2 (HSV-2)/HIV co-infection as a contributing factor in the increase in HIV infection among non-injecting heroin and cocaine users in New York City.MethodsSubjects were recruited from the Beth Israel Medical Center drug detoxification and methadone maintenance programs in New York City in 1995–1999 and 2005–2011. All reported current heroin and/or cocaine use and no injection drug use. A structured questionnaire was administered and serum samples collected for HIV and HSV-2 testing. Population-attributable risk percentages (PAR%s) were estimated for associations between HSV-2 and increased susceptibility to and increased transmissibility of HIV among female NIDUs.Results785 subjects were recruited from 1995–1999, and 1764 subjects from 2005–2011. HIV prevalence increased from 7% to 13%, with nearly uniform increases among all demographic subgroups. HSV-2/HIV co-infection was common in both time periods, with an average (over the two time periods) of 80% of HIV negative females infected with HSV-2, an average of 43% of HIV negative males infected with HSV-2; an average of 97% of HIV positive females also infected with HSV-2 and an average of 67% of HIV positive males also infected with HSV-2. The increase in HIV prevalence was predominantly an increase in HSV-2/HIV co-infection, with relatively little HIV mono-infection in either time period. The estimated PAR%s indicate that approximately half of HIV acquisition among females was caused by HSV-2 infection and approximately 60% of HIV transmission from females was due to HSV-2 co-infection.ConclusionsThe increase in HIV infection among these non-injecting drug users is better considered as an increase in HSV-2/HIV co-infection rather than simply an increase in HIV prevalence. Additional interventions (such as treatment as prevention and suppressing the effects of HSV-2 on HIV transmission) are needed to reduce further HIV transmission from HSV-2/HIV co-infected non-injecting drug users.

Do metropolitan HIV epidemic histories and programs for people who inject drugs and men who have sex with men predict AIDS incidence and mortality among heterosexuals?

PurposeWe focus on a little-researched issue—how human immunodeficiency virus (HIV) epidemics and programs in key populations in metropolitan areas affect epidemics in other key populations. We consider (1) How are earlier epidemics among people who inject drugs (PWID) and men who have sex with men (MSM) related to later AIDS incidence and mortality among heterosexuals?; (2) Were prevention programs targeting PWID or MSM associated with lower AIDS incidence and mortality among heterosexuals?; and (3) Was the size of the potential bridge population of noninjecting drug users (NIDUs) in a metropolitan area associated with later AIDS incidence and mortality among heterosexuals? MethodsUsing data for 96 large U.S. metropolitan areas, Poisson regression assessed associations of population prevalences of HIV-infected PWID and MSM (1992); NIDU population prevalence (1992–1994); drug use treatment coverage for PWID (1993); HIV counseling and testing coverage for MSM and for PWID (1992); and syringe exchange presence (2000) with CDC data on AIDS incidence and mortality among heterosexuals in 2006–2008, with appropriate socioeconomic controls. ResultsPopulation density of HIV+ PWID and of NIDUs were positively related, and prevention programs for PWID negatively related to later AIDS incidence among heterosexuals and later mortality among heterosexuals living with AIDS. HIV+ MSM population density and prevention programs for MSM were not associated with these outcomes. ConclusionsEfforts to reduce HIV transmission among PWID and NIDUs may reduce AIDS and AIDS-related mortality among heterosexuals. More research is needed at metropolitan area, network, and individual levels into HIV bridging across key populations and how interventions in one key population affect HIV epidemics in other key populations.