AEGiS-14IAC: Intensive injection cocaine use as a primary risk factor for HIV seroconversion in a cohort of poly-drug users in Vancouver, Canada.

14th International AIDS Conference


Barcelona, Spain - July 7-12, 2002

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Intensive injection cocaine use as a primary risk factor for HIV seroconversion in a cohort of poly-drug users in Vancouver, Canada.

Int Conf AIDS 2002 Jul 7-12; 14:(abstract no. ThOrC1394)

Tyndall MW, Spittal P, Li K, O'Shaughnessy MV, Schechter MT
BC Centre for Excellence in HIV/AIDS, Vancouver, Canada

BACKGROUND: Vancouver has experienced an explosive outbreak of HIV and Hepatitis C infection among injection drug users despite a legal needle exchange. This study was designed to determine how patterns of drug use influence HIV transmission and specifically to measure the impact of intensive injection cocaine use on HIV seroconversion.

METHODS: The Vancouver Injection Drug Users Study (VIDUS) is an open prospective cohort that has enrolled 1,416 active injection drug users between May 1996 and December 2001. Cox proportional hazards models were used to identify behavioral and drug use patterns that were reported during the six months prior to HIV seroconversion, and to measure a dose-response relationship for cocaine intensity and HIV serconversion .

RESULTS: Of 942 HIV-negative participants, we identified 109 seoconversions over a median follow-up of 32 months. In a model that included age, gender, ethnicity, commercial sex work, condom use, drug treatment, and poly-drug use patterns, independent predictors of HIV seroconversion were any injection cocaine use [Adjusted Hazards Ratio (AHR, 3.5)], incarceration (AHR, 2.3) unstable housing (AHR, 2.2), and borrowing used needles (AHR, 2.0). Further, injection cocaine use was associated with HIV incidence in a dose-dependent fashion. Compared with infrequent or non-cocaine users, HIV seroconversion was higher among those injecting up to 1/wk (AHR, 1.9), higher still among those injecting up to 3 times/day (AHR, 4.3), and highest among those injecting in excess of 4 times/day (AHR,7.4).

CONCLUSIONS: Cocaine injection is a strong, dose-dependent predictor of HIV seroconversion in our community. Erratic, high-intensity drug use is characteristic of cocaine users and this greatly impairs decisions regarding safe needle use. Cocaine injection as a primary risk factor for HIV infection is a global concern, and current strategies to manage cocaine dependency remain woefully inadequate.

Keywords: AEGIS, Risk Factors, HIV Seropositivity, Cocaine-Related Disorders, HIV Infections, Incidence, Canada, Injections, Disease Outbreaks, Proportional Hazards Models, Cocaine, Hepatitis C, EpidemiologyKWDaegis,riskfactors,hivseropositivity,cocaine-relateddisorders,hivinfections,incidence,canada,injections,diseaseoutbreaks,proportionalhazardsmodels,cocaine,hepatitisc,epidemiology

020707
ThOrC1394

Copyright © 2002 - International AIDS Society (IAS). Reproduction of this abstract (other than one copy for personal reference) must be cleared through the IAS.