American Journal of Epidemiology Vol. 146, No. 12: 994-1002
Copyright © 1997 by The Johns Hopkins University School of Hygiene and Public Health
research-article |
High Rates of HIV Infection among Injection Drug Users Participating in Needle Exchange Programs in Montreal: Results of a Cohort Study
1Department of Psychiatry, University of Montreal Montreal, Quebec, Canada
2Department of Microbiology and Immunology, University of Montreal Montreal, Quebec, Canada
3Department of Oncology, McGill University Montreal, Quebec, Canada
4Epidemiology and Biostatistics Unit, Armand-Frappier Institute Laval, Quebec, Canada
5Laval Public Health Unit Laval, Quebec, Canada
Reprint requests to Dr. Julie Bruneau, Pavilion Saint-Luc, Centre Hospitalier de I'Université de Montréal, 1058 Saint-Denis Street, Montréal, QC, Canada H2X 3J4
Needle exchange programs (NEPs) are designed to prevent human immunodeficiency virus (HIV) transmission among injection drug users. Although most studies report beneficial effects in terms of behavior modification, a direct assessment of the effectiveness of NEPs in preventing HIV infection has been lacking. A cohort study was conducted to assess the association between risk behaviors and HIV seroprevalence and seroincidence among injection drug users in Montreal, Canada. The association between NEP use and HIV infection was examined in three risk assessment scenarios using intensive covariate adjustment for empirical confounders: a cross-sectional analysis of NEP use at entry as a determinant of seroprevalence, a cohort analysis of NEP use at entry as a predictor of subsequent seroconversion, and a nested case-control analysis of NEP participation during follow-up as a predictor of seroconversion. From September 1988 to January 1995, 1,599 subjects were enrolled with a baseline seroprevalence of 10.7%. The mean follow-up period was 21.7 months. The adjusted odds ratio for HIV seroprevalence in injection drug users reporting recent NEP use was 2.2 (95% confidence interval 1.5–3.2). In the cohort study, there were 89 incident cases of HIV infection with a cumulative probability of HIV seroconversion of 33% for NEP users and 13% for nonusers (p < 0.0001). In the nested case-control study, consistent NEP use was associated with HIV seroconversion during follow-up (odds ratio = 10.5, 95% confidence interval 2.7–41.0). Risk elevations for HIV infection associated with NEP attendance were substantial and consistent in all three risk assessment scenarios in our cohort of injection drug users, despite extensive adjustment for confounders. In summary, in Montreal, NEP users appear to have higher seroconversion rates then NEP nonusers. Am J Epidemiol 1997;146:994–1002.
cohort studies; HIV; needle exchange programs; substance abuse; substance abuse; Intravenous
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  J Bruneau, M Daniel, Y Kestens, G Zang, and M Genereux Associations between HIV-related injection behaviour and distance to and patterns of utilisation of syringe-supply programmes J Epidemiol Community Health, September 1, 2008; 62(9): 804 - 810. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. C. Des Jarlais, Z. Sloboda, S. R. Friedman, B. Tempalski, C. McKnight, and N. Braine Diffusion of the D.A.R.E and Syringe Exchange Programs Am J Public Health, August 1, 2006; 96(8): 1354 - 1358. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. E. Nelson, N. Galai, M. Safaeian, S. A. Strathdee, D. D. Celentano, and D. Vlahov Temporal Trends in the Incidence of Human Immunodeficiency Virus Infection and Risk Behavior among Injection Drug Users in Baltimore, Maryland, 1988-1998 Am. J. Epidemiol., October 1, 2002; 156(7): 641 - 653. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Safaeian, R. Brookmeyer, D. Vlahov, C. Latkin, M. Marx, and S. A. Strathdee Validity of Self-reported Needle Exchange Attendance among Injection Drug Users: Implications for Program Evaluation Am. J. Epidemiol., January 15, 2002; 155(2): 169 - 175. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. M. Patrick, M. W. Tyndall, P. G.A. Cornelisse, K. Li, C. H. Sherlock, M. L. Rekart, S. A. Strathdee, S. L. Currie, {d.{d. Schechter, and M. V. O'Shaughnessy Incidence of hepatitis C virus infection among injection drug users during an outbreak of HIV infection Can. Med. Assoc. J., October 1, 2001; 165(7): 889 - 895. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. A. Strathdee, N. Galai, M. Safaiean, D. D. Celentano, D. Vlahov, L. Johnson, and K. E. Nelson Sex Differences in Risk Factors for HIV Seroconversion Among Injection Drug Users: A 10-Year Perspective Arch Intern Med, May 28, 2001; 161(10): 1281 - 1288. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. R. Seage III, S. E. Holte, D. Metzger, B. A. Koblin, M. Gross, C. Celum, M. Marmor, G. Woody, K. H. Mayer, C. Stevens, et al. Are US Populations Appropriate for Trials of Human Immunodeficiency Virus Vaccine? : The HIVNET Vaccine Preparedness Study Am. J. Epidemiol., April 1, 2001; 153(7): 619 - 627. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Bruneau, F. Lamothe, J. Soto, N. Lachance, J. Vincelette, A. Vassal, and E. L. Franco Sex-specific determinants of HIV infection among injection drug users in Montreal Can. Med. Assoc. J., March 1, 2001; 164(6): 767 - 773. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
Injection drug use and preventive measures: a comparison of Canadian and Western European jurisdictions over time Can. Med. Assoc. J., June 1, 2000; 162(12): 1709 - 1713.
|
|
|
|
 |
|
 Needle Exchange and HIV Rates AIDS Clinical Care, April 1, 1998; 1998(401): 5 - 5. [Full Text]
|
|
|
|
 |
|
 Impact of Needle Exchange Programs on HIV Acquisition Journal Watch Infectious Diseases, February 1, 1998; 1998(201): 11 - 11. [Full Text]
|
|