American Journal of Epidemiology Vol. 155, No. 2 : 159-168
Copyright © 2002 by The Johns Hopkins University School of Hygiene and Public Health
ORIGINAL CONTRIBUTIONS |
Subtype-specific Transmission Probabilities for Human Immunodeficiency Virus Type 1 among Injecting Drug Users in Bangkok, Thailand
1 Department of Biostatistics, Rollins School of Public Health, Emory University, Atlanta, GA.
2 Fred Hutchinson Cancer Research Center, Seattle, WA.
3 Bangkok Metropolitan Administration, Bangkok, Thailand.
4 Division of HIV/AIDS Prevention, National Center for HIV, STD & TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA.
5 Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
6 HIV/AIDS Collaboration, Nonthaburi, Thailand.
The Bangkok (Thailand) Metropolitan Administration cohort of injecting drug users (IDUs) consisted of 1,209 IDUs initially seronegative for human immunodeficiency virus (HIV) who were followed from 1995 to 1998 at 15 Administration drug treatment clinics. At enrollment and approximately every 4 months thereafter, participants were assessed for HIV seropositivity. As of December 1998, there were 133 HIV type 1 seroconversions and approximately 2,300 person-years of follow-up. Of the 133 observed seroconversions, specimens from 126 persons were available for subtyping (27 subtype B, 99 subtype E). In this analysis, the authors assessed differences in subtype-specific transmission while controlling for important risk factors. The methodology used accounts for left truncation, interval censoring, and competing risks as well as for time-varying covariates such as each IDU's history of reported frequency of injection and of incarceration. Using plausible epidemiologic assumptions and controlling for behavioral risks, the authors found that a significantly higher transmission probability was associated with subtype E compared with subtype B in this population. Since many epidemiologic, virologic, and host factors can influence HIV transmission, it was difficult to conclude whether these differences in transmission probabilities were due to biologic properties associated with subtype.
disease transmission; HIV; HIV infections; HIV-1; risk; risk factors; survival analysis
Abbreviations: CDF, cumulative distribution function; HIV, human immunodeficiency virus; HIV-1, human immunodeficiency virus type 1; IDU, injecting drug user
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