RESUMEN
BACKGROUND: Human T-lymphotropic virus type II (HTLV-II) is widespread among injecting drug users (IDU) and may contribute to the risk of leukemia/lymphoma, neurodegenerative disease, and perhaps pneumonia, especially with HIV co-infection. METHODS: In 1987--1991, 6570 IDU were tested for HIV and HTLV-II antibodies. In 1998, they were matched to the National Death Index. Numbers of observed deaths of each cause were compared by standardized mortality ratios with the numbers expected, using sex-, race-, age-, and year-specific rates in the general population. Relative risk (RR) associated with each virus, compared to uninfected drug users, was estimated by Poisson modeling. RESULTS: There were 1351 deaths, including 683 (15%) of 4604 participants who enrolled seronegative for both viruses; 328 (47%) of 701 who had HIV but not HTLV-II infection; 220 (21%) of 1033 who had HTLV-II but not HIV infection; and 120 (52%) of 232 who were infected by both viruses. Compared to the general population, mortality for participants with neither virus was increased 4.3-fold [95% confidence interval (CI), 4.0--4.7] and was significantly elevated for virtually every cause of death. With HIV, mortality from medical causes, but not external causes, was increased 3.7-fold (95% CI, 3.3--4.2), particularly with AIDS and related conditions. With HTLV-II, all-cause mortality was reduced (RR, 0.8; 95% CI, 0.7--0.9), with no statistically significant reduction or elevation for any specific cause. A non-significant excess of tuberculosis deaths (RR, 4.6; 95% CI, 0.8--25.2) was noted with HTLV-II, but there was no excess mortality from leukemia/lymphoma, other malignancies, or neurodegenerative disease. CONCLUSIONS: Without HIV or HTLV-II, IDU had profoundly increased mortality from medical and external causes. HIV was specifically associated with death due to AIDS and related conditions. HTLV-II infection was not significantly associated with mortality from any cause, suggesting that it is not a significant human pathogen, even when present with HIV infection.
Asunto(s)
Causas de Muerte , Infecciones por VIH/mortalidad , Infecciones por HTLV-II/mortalidad , Abuso de Sustancias por Vía Intravenosa , Estudios de Cohortes , Infecciones por VIH/epidemiología , Seroprevalencia de VIH , Humanos , Factores de Riesgo , Estados Unidos/epidemiologíaRESUMEN
A study was made of the effectiveness of an aftercare program operating in conjunction with area outpatient drug free treatment programs while organizationally independent of those programs. Parolees and probationers mandated to treatment were assigned to aftercare on the basis of residence in the catchment areas in which aftercare facilities were located (n = 32) and randomly to aftercare (n = 62) and control (n = 51) when not a resident in a catchment area. No outcome differences were found between aftercare groups based on proximity to facility. At 6 months postbaseline the combined aftercare group showed significantly lower levels of criminal activity and frequent drug use as compared to controls. At 12 months postbaseline there was an attenuation of group differences with only tendencies toward significance obtained for lower levels of frequent drug use by the aftercare group. The findings are discussed in terms of the relevance of community variables for programming and for understanding long-term treatment outcomes.
Asunto(s)
Cuidados Posteriores/psicología , Crimen , Trastornos Relacionados con Sustancias/terapia , Resultado del Tratamiento , Adulto , Baltimore , Coerción , Femenino , Estudios de Seguimiento , Humanos , Masculino , Centros de Tratamiento de Abuso de Sustancias , Trastornos Relacionados con Sustancias/psicología , Factores de TiempoRESUMEN
Although the effectiveness of drug abuse treatment has been demonstrated repeatedly, many drug abusers do not enter treatment, many who do enter leave prematurely, and relapse following treatment is common. To further research treatment entry and engagement, the National Institute on Drug Abuse convened scientists representing diverse research traditions in December 1996. This article summarizes meeting presentations and recommendations. Presentations focused on treatment readiness/motivation for change, ethnographic reports of drug abusers' perceptions of and attitudes toward treatment, and reports on alternative treatments for high-risk drug abusers. Recommendations focused on the potential contribution of qualitative research, integration of qualitative and quantitative research approaches, development of flexible treatment approaches that are cognizant of patients' life circumstances, and services research to improve the organization and delivery of drug abuse treatment.
Asunto(s)
Cooperación del Paciente , Trastornos Relacionados con Sustancias/terapia , Actitud del Personal de Salud , Etnicidad , Humanos , Estilo de Vida , Desarrollo de Programa , Asunción de RiesgosRESUMEN
Several important findings from the drug abuse treatment outcome studies (DATOS) are presented in this issue of drug and alcohol dependence. These studies focus on the drug abuse treatment process in areas of engagement in treatment and participation in program activities, the effect of the patient's age and treatment history in predicting treatment retention and outcomes, and the impact of prior treatment experience on the level of treatment engagement and subsequent outcomes. A cost-benefit model for drug abuse treatment is developed. Significant contributions are made in the development of a comprehensive model of the treatment process, including the relationship of patient attributes, program factors, and outcomes. Findings on retention from the United Kingdom's national treatment outcome research study (NTORS), a study similar in design to DATOS, also are presented.
Asunto(s)
Trastornos Relacionados con Sustancias/rehabilitación , Factores de Edad , Análisis Costo-Beneficio/economía , Humanos , Trastornos Relacionados con Sustancias/economía , Trastornos Relacionados con Sustancias/psicología , Resultado del TratamientoRESUMEN
Trends in HIV infection and AIDS risk behaviors among injecting drug users (IDUs) were assessed through a series of nonblinded point-prevalence surveys conducted between 1987 and 1991 with admissions to methadone treatment in eight areas, including New York City; Asbury Park and Trenton, New Jersey; Philadelphia; Baltimore; Chicago; San Antonio, Texas; and Los Angeles County. Over the 5-year period, significant changes in HIV seropositivity were found in two of the eight cities, with seroprevalence decreasing in Asbury Park from 43.1 to 21.2% and increasing from 10.1 to 17.6% in Chicago. Initially high levels of injection-related risk behaviors decreased substantially across cohorts in most cities, except for San Antonio and Los Angeles, where risk levels remained high. Sexual risk behaviors continued at high levels in all cities, suggesting relatively little sexual risk reduction during the course of the study.
Asunto(s)
Infecciones por VIH/epidemiología , Seroprevalencia de VIH/tendencias , Asunción de Riesgos , Abuso de Sustancias por Vía Intravenosa/complicaciones , Estudios de Cohortes , Humanos , Metadona/uso terapéutico , Programas Nacionales de Salud , Compartición de Agujas , Oportunidad Relativa , Cooperación del Paciente , Conducta Sexual , Abuso de Sustancias por Vía Intravenosa/tratamiento farmacológico , Estados Unidos/epidemiologíaRESUMEN
Seroprevalence of human T lymphotropic virus (HTLV) and human immunodeficiency virus type 1 (HIV-1) was determined among 7841 intravenous drug users (IVDUs) from drug treatment centers in Baltimore, Chicago, Los Angeles, New Jersey (Asbury Park and Trenton), New York City (Brooklyn and Harlem), Philadelphia, and San Antonio, Texas; 20.9% had evidence of HTLV infection, as determined using a p21e EIA for screening and p21e blot for confirmation. With a type-specific EIA and blot used in combination, HTLV-II was identified in 97.6% of HTLV-positive IVDUs whose sera could be subtyped. HIV-1 seroprevalence was 13.2%. HTLV-II without HIV-1 was most common in Los Angeles and San Antonio. HIV-1 without HTLV-II was most common in New York, New Jersey, and Baltimore. Dual infection was most common in New York and New Jersey. Logistic regression analysis revealed that seroprevalence of HTLV-II was significantly greater with HIV-1 infection and increasing age and among women, blacks, and Mexican-Americans. In conclusion, it appears that among US IVDUs, nearly all HTLV infection is attributable to HTLV-II, and HTLV-II infection is associated with HIV-1 and sociodemographic background.
Asunto(s)
Síndrome de Inmunodeficiencia Adquirida/epidemiología , Infecciones por VIH/complicaciones , Infecciones por VIH/epidemiología , Infecciones por HTLV-II/complicaciones , Infecciones por HTLV-II/epidemiología , Abuso de Sustancias por Vía Intravenosa , Síndrome de Inmunodeficiencia Adquirida/complicaciones , Adolescente , Adulto , Negro o Afroamericano , Factores de Edad , Demografía , Etnicidad , Femenino , Anticuerpos Anti-VIH/sangre , Seroprevalencia de VIH , VIH-1 , Anticuerpos Anti-HTLV-II/sangre , Humanos , Masculino , Americanos Mexicanos , Grupos Raciales , Factores Sexuales , Estados Unidos/epidemiología , Población UrbanaRESUMEN
OBJECTIVES: To examine factors associated with HIV infection in injecting drug users (IDU), the independent and interactive effects of potential risk factors, and geographic differences in risk factors. METHODS: IDU entering methadone treatment in New York City, Asbury Park and Trenton in New Jersey, Baltimore and Chicago between February 1987 and December 1991 were interviewed using a standard questionnaire and tested for HIV antibodies (n = 4584). Associations of HIV serostatus with race/ethnicity, other demographic characteristics, and injecting and sexual risk behaviors were assessed by logistic regression analyses. RESULTS: African Americans were at increased risk for HIV in four of the five cities, and Puerto Ricans in two cities. Injection in shooting galleries and 'speedball' injection emerged as behavioral variables highly associated with HIV, although interaction of these variables indicates that each variable contributes to HIV risk only in the absence of the other behavior. CONCLUSIONS: Geographic differences in HIV risk factors and the interaction of 'speedball' and shooting gallery use suggest that multiple HIV risk models are needed that reflect seroprevalence rates, variation in risk behaviors, and the social context of risk behaviors. Increased risk among racial/ethnic minorities independent of risk behaviors, suggests the need to examine further potential social and environmental factors, such as the social networks in which injecting and sexual behaviors occur, HIV seroprevalence within these networks, and the locales in which risk behaviors occur.
Asunto(s)
Infecciones por VIH/epidemiología , Abuso de Sustancias por Vía Intravenosa/epidemiología , Adulto , Negro o Afroamericano/estadística & datos numéricos , Baltimore/epidemiología , Chicago/epidemiología , Cocaína , Comorbilidad , Conducta Peligrosa , Femenino , Infecciones por VIH/etnología , Infecciones por VIH/transmisión , Seropositividad para VIH/epidemiología , Hispánicos o Latinos/estadística & datos numéricos , Humanos , Masculino , Americanos Mexicanos/estadística & datos numéricos , Análisis Multivariante , Compartición de Agujas/estadística & datos numéricos , New Jersey/epidemiología , Ciudad de Nueva York/epidemiología , Oportunidad Relativa , Puerto Rico/etnología , Factores de Riesgo , Conducta Sexual/estadística & datos numéricos , Trastornos Relacionados con Sustancias/epidemiología , Estados Unidos/epidemiología , Población UrbanaRESUMEN
The relationship of age at first injection and HIV risk was explored in a nonblinded HIV seroprevalence study of intravenous drug users (IVDUs) admitted to methadone treatment in seven United States cities between February 1987 and June 1989. Comparisons were made of IVDUs who began injecting as adolescents, young adults, and adults in terms of drug use and sexual HIV risk behaviors and HIV serostatus. Early injectors consistently reported higher levels of drug-using risk behaviors (e.g., frequency of injection, frequency of needle sharing, and use of shooting galleries), and were more likely to be HIV seropositive. Among females, early injectors were also more likely to report sexual risk behaviors (e.g., multiple sex partners, prostitution). The relationship of age at first injection with selected risk behaviors and HIV serostatus was independent of subjects' age at interview, gender, and race/ethnicity. This study suggests that adolescent injectors are an important target group for HIV prevention efforts.
Asunto(s)
Seroprevalencia de VIH , Abuso de Sustancias por Vía Intravenosa/epidemiología , Adolescente , Adulto , Factores de Edad , Actitud Frente a la Salud , Niño , Estudios de Cohortes , Etnicidad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Factores de Riesgo , Asunción de Riesgos , Conducta Sexual/estadística & datos numéricos , Estados Unidos/epidemiologíaRESUMEN
To assess trends in HIV infection and AIDS risk behaviors among intravenous drug users (IVDUs), a series of nonblinded point-prevalence surveys was conducted with admissions to methadone treatment in seven areas, including New York City; Trenton and Asbury Park, New Jersey; Baltimore; Chicago; San Antonio, Texas; and Los Angeles County between February and December 1987 (n = 713), January and June 1988 (n = 1,089), July and December 1988 (n = 932), and January and June 1989 (n = 1,110). Over the 2-year period, significant changes in HIV seropositivity levels were found in only one of the seven cities (Chicago, with levels increasing from 8.4 to 14.7%). High levels of AIDS risk behaviors (frequency of injection, needle sharing, needle cleaning, and use of shooting galleries) were found in all cities. Comparisons of trends in recent risk behaviors (past year) within cities suggest that relatively little reduction in AIDS risk behaviors had occurred during the study.
Asunto(s)
Síndrome de Inmunodeficiencia Adquirida/complicaciones , Infecciones por VIH/complicaciones , Metadona/uso terapéutico , Asunción de Riesgos , Abuso de Sustancias por Vía Intravenosa/tratamiento farmacológico , Síndrome de Inmunodeficiencia Adquirida/epidemiología , Síndrome de Inmunodeficiencia Adquirida/psicología , Adulto , Estudios de Cohortes , Femenino , Infecciones por VIH/epidemiología , Infecciones por VIH/psicología , Humanos , Masculino , Abuso de Sustancias por Vía Intravenosa/complicaciones , Abuso de Sustancias por Vía Intravenosa/epidemiología , Estados Unidos/epidemiologíaRESUMEN
Data from a continuing multiyear seroprevalence survey of human T-lymphotropic virus types I or II (HTLV-I/II) among intravenous drug users in seven U.S. locations were analyzed to detect demographic patterns of seropositivity and coinfection with human immunodeficiency virus type 1 (HIV-1). Seropositivity for HTLV-I/II and HIV-1 was detected by whole-virus enzyme immunoassay, with Western blot confirmation. Of 1,800 subjects recruited from methadone maintenance and detoxification clinics, 207 (11.5%) were infected with HTLV-I/II. Seropositivity for HTLV-I/II varied by racial group, age, sex, and geographic location. Blacks had a higher (age- and location-adjusted) infection rate (17.1%) than Hispanics (8.7%) or whites (5.6%), and seropositivity showed a strong gradient with increasing age. Females had a slightly higher rate (14.0%) than males (10.0%), after adjustment for age and location. Among the seven locations, the rate varied from approximately 1% (Miami and Baltimore) to 20% (Los Angeles), although the former rates were based on relatively few subjects (47 and 65, respectively). Overall, the occurrence of coinfection by HIV-1 and HTLV-I/II did not occur more frequently than expected by chance.
Asunto(s)
Síndrome de Inmunodeficiencia Adquirida/epidemiología , Infecciones por HTLV-I/epidemiología , Infecciones por HTLV-II/epidemiología , Abuso de Sustancias por Vía Intravenosa , Síndrome de Inmunodeficiencia Adquirida/complicaciones , Adulto , Negro o Afroamericano , Factores de Edad , Femenino , Seroprevalencia de VIH , Infecciones por HTLV-I/complicaciones , Infecciones por HTLV-II/complicaciones , Hispánicos o Latinos , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Abuso de Sustancias por Vía Intravenosa/complicaciones , Estados Unidos/epidemiología , Población BlancaRESUMEN
To examine sexual transmission of human immunodeficiency virus (HIV) among heterosexual intravenous drug users (IVDUs), HIV antibody status of IVDUs with intravenous drug-using sexual partners (IVSPs) was compared with that of IVDUs with no IVSPs. Initial bivariate analyses indicated IVDUs with IVSPs were more likely to be HIV antibody-positive than those with no IVSPs. Analyses by gender indicated that this relationship held for men but not women. IVDUs with IVSPs also differed from those without IVSPs demographically, in drug use, and in other sexual behaviors. When effects of other variables were controlled, no statistically significant relationship was found between injection history of sex partners and HIV status for the total sample or separately for men or women.
Asunto(s)
Infecciones por VIH/transmisión , Conductas Relacionadas con la Salud , Conducta Sexual , Parejas Sexuales , Abuso de Sustancias por Vía Intravenosa/complicaciones , Adulto , Negro o Afroamericano , Femenino , Anticuerpos Anti-VIH/análisis , Infecciones por VIH/complicaciones , Hispánicos o Latinos , Humanos , Masculino , Análisis Multivariante , Agujas , Análisis de Regresión , Encuestas y CuestionariosRESUMEN
Drug abusers currently represent almost 30% of AIDS cases reported to the Centers for Disease Control. Intravenous drug abusers have been recognized as a major vector for the spread of HIV to the general public. Considering the high levels of AIDS risk behaviors among intravenous drug abusers, prevention efforts to reduce risk are a priority. Since community prevention approaches have been found effective with other target populations, this article considers community prevention as an AIDS reduction strategy. Consensus recommendations developed by a panel of researchers and practitioners who met at the National Institute on Drug Abuse in 1988 are presented. Specific recommendations for community prevention with intravenous drug abusers and their sex partners are introduced along with suggested research initiatives.