Important note: Information in this article was accurate in 1990. The state of the art may have changed since the publication date.
THE EPIDEMIOLOGY OF AIDS: PARENTERAL DRUG USERS
The Epidemiology of AIDS: Expression, Occurrence, and Control of Human Immunodeficiency Virus Type 1 Infection. Kaslow RA and Francis DP, eds. New York, Oxford University Press, p. 153-78, 1989.. Unique Identifier : AIDSLINE ICDB/90668116 Friedland G; Montefiore Medical Center, Albert Einstein Coll. of Medicine, 111; E. 210th St., Bronx, NY 10467
Abstract:
Three features of illicit drug use during the past century have provided a fertile field for the amplification of HIV transmission: (1) an epidemic of drug use; (2) a change to the iv method of administration; and (3) an increase in needle-sharing behavior. The epidemiology of AIDS among parenteral drug users is reviewed, including: reports of AIDS among iv drug users; demographic features of iv drug users with AIDS; seroprevalence of HIV-1 infection among iv drug users; factors associated with infection; clinical and immunological manifestations of HIV-1 infection among iv drug users; iv drug abuse and nonabuser populations; and reduction of risk among iv drug users. By mid-1982 the occurrence of AIDS in heterosexual men and women who used iv drugs was recorded in national statistics in the USA. AIDS in iv drug users also has been extensively documented in Europe. The AIDS virus has not been cultured from contaminated needles and syringes; however epidemiologic studies strongly support the association of both needle sharing and nonsexual factors with HIV-1 transmission. Age and gender do not appear to be associated independently with seropositivity, but prostitution, frequent sexual contact with other iv drug users, and exposure to large numbers of sexual partners do appear to be related. The relative contribution of transmission by iv and sexual routes among sexually active iv drug users is unknown, although it is logical to expect an additive risk. The effect of AIDS-specific mortality among iv drug users, a group with an already exaggerated mortality rate compared to that of the general population, has been substantial and is increasing dramatically. A substantial uninfected, but at risk, population still exists, and with it a temporary window of opportunity to interrupt transmission in the population. The immunologic and clinical abnormalities described as part of iv drug use itself may result in diagnostic confusion in individual patients. The clinical spectrum of AIDS among iv drug users is similar to that of other groups at risk. Iv drug users infected with HIV-1 represent a major bridge to other adult populations through heterosexual transmission and to children via perinatal transmission. Programs to reduce, if not eliminate, needle sharing among iv drug users must be introduced as emergency measures to reduce HIV-1 transmission. (130 Refs)
Keywords: Acquired Immunodeficiency Syndrome/EPIDEMIOLOGY/*TRANSMISSION Cross-Sectional Studies *Disease Outbreaks Female Human HIV Infections/EPIDEMIOLOGY/*TRANSMISSION HIV Seroprevalence HIV-1/*PATHOGENICITY Incidence Male Needles Risk Factors Sexual Partners Substance Abuse, Intravenous/*COMPLICATIONS/EPIDEMIOLOGY United States/EPIDEMIOLOGY MONOGRAPH REVIEW, TUTORIAL REVIEW 901230
M90C3731
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Important note: Information in this article was accurate in 1990. The state of the art may have changed since the publication date.
