四川省凉山地区静脉吸毒人群药物滥用及其行为特征调查

目的:了解四川省凉山地区静脉吸毒人群药物滥用及行为特征情况,为采取有针对性的戒毒干预措施预防艾滋病病毒的传播提供数据.方法:以社区为基础招募了379名静脉吸毒人员,调查其人口学特征,艾滋病病毒感染情况,药物滥用的种类、吸毒方式和频率,口吸和静脉吸毒时间,共用注射器具情况等.结果:静脉吸毒人群艾滋病病毒感染率为11.3%(43/379).379名被调查者全部为海洛因滥用者,其中247人(65.2%)单独使用过海洛因,297人(78.4%)混合注射过海洛因与安定,滥用过的其他药物有安定(8.2%)和鸦片(1.3%).300人(79.2%)每天静脉注射吸毒一次及以上;曾经共用注射器具静脉吸毒的为247人(65.2%),87人(35.2%)首次静脉注射吸毒即与他人共用注射器具;初次口吸吸毒和静脉注射吸毒的平均年龄分别为22.37岁和25.35岁,口吸吸毒和静脉注射吸毒的平均时间分别为6.41年和3.42年.结论:加强青少年、吸毒人员关于毒品危害和拒绝毒品的健康教育活动,以及开展美沙酮或丁丙诺啡口服治疗海洛因依赖者,降低静脉注射吸毒行为,控制艾滋病病毒的传播.     

海洛因依赖者脱毒期间发生急性胃穿孔的特点与防治

目的··:总结海洛因依赖者在脱毒过程中发生急性胃穿孔的发病原因、临床特点和防治方法。方法··:对我所1997年1月 -1999年3月收治的32例海洛因依赖者并发急性胃穿孔的临床资料进行回顾性分析 ;结果··:32例患急性胃穿孔的海洛因依赖者中 ,男性31例 ,(占96.8 %),女性1例 (占3.1 % );采用自然戒断法 (冷火鸡法 )脱毒者27例(占84.3 %);既往有胃病史者25例(占78.1 %);脱毒1周内发病者31例(占96.8 %);日滥用量>0.6g发病者28例(占87.5 %) ;吸毒年限1.9 -3a发病者26例(占81.3 %);采用烫吸 +静脉注射 +肌肉注射吸毒方式发病者30例(占93.7 %)。结论··:既往有胃病史的男性海洛因依赖者 ,采用自然戒断脱毒法的1周内最容易发生急性胃穿孔 ;急性胃穿孔的发生与海洛因滥用量、吸毒时间和吸毒方式有一定的关系 ;建议对上述患者应采用药物脱毒且适当延长脱毒时间     

331例海洛因依赖者呼吸系统疾病调查

目的··:了解海洛因依赖者呼吸系统并发疾病的发生率及其与海洛因滥用的相关性。方法··:连续抽取1999年3月 -1999年10月在我院强制戒毒的331例海洛因依赖者病历进行回顾性调查。结果··:331例海洛因依赖者中有呼吸系统并发疾病的178例 ,占53.78 %;吸毒时间在1a以上的有呼吸系统并发疾病的比例明显高于吸毒时间低于1a者 (χ2=24.66,P<0.01);注射方式吸毒的呼吸系统并发疾病的比例明显高于单纯烫吸的 (χ2=6.35,P<0.05)。结论··:呼吸系统并发疾病是海洛因依赖人群中最常见的并发疾患。海洛因滥用方式、滥用时间与呼吸系统并发疾病有相关性。     

海洛因滥用对呼吸系统的损害及病理生理变化

海洛因对机体呼吸机制呈现强大的中枢抑制作用,这是海洛因过量中毒致死的主要原因之一。有报告,在海洛因成瘾引起的并发症中,呼吸系统并发症占21%～91%,是海洛因依赖人群最常见的并发疾患。也有报告,在静脉滥用海洛因依赖者中2/3患有肺部并发疾患。有相当一部分海洛因滥用者吸毒的初始原因就是为医治呼吸系统疾病而误染毒品,终至形成海洛因依赖而不能自拔。一、呼吸道感染性疾患海洛因依赖者以烫吸(锡纸燃吸)和烟吸(掺入卷烟中)方式吸毒时,海洛因直接刺激呼吸道粘膜;静脉注射海洛因时,海洛因经血液循环作用于呼吸粘膜,同样造成呼吸道粘膜上…     

327例海洛因依赖者HCV感染情况分析

目的:了解不同吸毒方式海洛因依赖者的HCV感染与肝功能异常情况,评估HCV感染和吸毒方式与性别、年限的关系.方法:327例海洛因依赖者入院时均进行血清HCV标志物及丙氨酸氨基转移酶(ALT)检测.结果:327例海洛因依赖者中,HCV感染114例(34.9%),ALT异常41例(12.5%).在注射方式依赖者中,感染率为62.3%(71/114);HCV感染与性别无关,与注射吸毒年限有关.吸毒年限≤1年的,感染率为36.8%,吸毒年限＞1年的,感染率为75.0%.烫吸方式依赖者,感染率为0.ALT异常主要与HCV感染有关.结论:注射方式吸食海洛因是海洛因依赖者感染HCV的主要因素,且感染率与注射吸毒年限呈正相关.     

2686例海洛因依赖者HCV感染情况分析

目的:探讨海洛因依赖者HCV流行情况及感染因素,为防止海洛因依赖人群中HCV感染提供有效途径.方法:对2002年1月-2004年6月收入院的2 686例海洛因依赖者进行抗-HCV实验室检测,对抗-HCV阳性者按吸毒方式分为烫吸组和静脉注射组,对两组HCVAb阳性率进行统计分析.结果:静脉注射组HCVAb阳性率明显高于烫吸组,吸毒时间在2 a以上者HCVAb阳性率明显高于2 a以下者,女性吸毒者HCVAb阳性率高于男性吸毒者.结论:静脉注射毒品是HCV感染的重要途径.对吸毒者进行预防HCV感染的相关知识的宣传教育及危险行为的干预是十分重要的.     

1000例海洛因依赖者中HCV感染情况分析

目的:研究海洛因依赖者HCV流行情况及感染因素,为防止海洛因依赖人群中HCV感染提供理论依据和有效途径。方法:对2000年1-12月收入院的1000例海洛因依赖者进行抗-HCV实验室检测,对抗-HCV阳性的逐一登记,按吸毒方式分为烫吸组和静脉注射组,对两组HCVAb阳性率进行统计学分析。结果:静脉注射组HCVAb阳性率明显高于烫吸组(P<0.01),女性吸毒人员HCVAb阳性率高于男性(P<0.01),吸毒时间在1a(含1a)以上HCVAb阳性率明显高于1a以下者。结论:静脉注射毒品是HCV感染的重要因素。对吸毒者进行HCV感染的相关知识的宣传教育及危险行为的干预十分重要。     

2084例海洛因依赖者脱毒期间发生急性胃炎的分析

目的:研究海洛因依赖者脱毒期间并发急性胃炎的情况。方法:采用回顾性研究方法,收集2003年1月至2004年1月期间,经胃镜检查伴有急性胃炎的海洛因依赖者2084例的临床资料,并分析急性胃炎与海洛因的用法、用量、持续时间及戒断时间的关系。结果:2084例海洛因依赖者中有442例(21.21%)脱毒期间发生急性胃炎;并发现日滥用量大、戒断时间长、吸毒年限长、静脉注射者急性胃炎的发生率高(P<0.01)。结论:海洛因依赖者脱毒期间可能发生急性胃炎,应予以注意。     

对贵阳市100例女性吸毒者的艾滋病知识、态度调查

目的:了解女性吸毒者对艾滋病的态度和相关知识掌握情况。方法:对2000年在贵阳市公安局戒毒中心强制戒毒的100名女性海洛因依赖者进行匿名问卷调查。结果:该吸毒群体中以烫吸方式滥用毒品者占81.0％,静脉注射方式占7.0％,烫吸、静脉注射混用方式占12.0％;与他人合用过注射器的占静脉注射者的47.4％;知道艾滋病是传染病的占93.0％;知道共用注射器可以传播艾滋病的占83.0％;知道孕妇可将艾滋病病毒传染给胎儿的占50.0％;知道艾滋病病毒主要侵害免疫系统的占31.0％;知道艾滋病是可预防的占63.0％;知道艾滋病是不可治愈的占49.0％;知道安全套可预防艾滋病感染的占34.0％,对预防艾滋病所采取的保护措施的应答中,肯定应答率最高的一项为35.0％。结论:本调查显示,贵阳地区女性吸毒者对艾滋病的传播方式仍缺乏全面了解,对预防知识的了解仍很贫乏,提示在该群体中进行艾滋病知识的宣传、教育和行为干预,对遏制艾滋病的传播、减少危害有极其重要的意义。     

5386例海洛因依赖者梅毒检测结果分析

目的：了解海洛因依赖者梅毒感染的原因、发病率，为减少危害提供依据。方法：对5386例海洛因依赖者采用TRUST初筛，阳性者加做TPHA检测确证试验。结果：5386例海洛因依赖者TRUST初筛试验阳性者138例，初筛试验阳性率为2.56％；其中126例TPPA确证试验为阳性；在这126例确证试验阳性患者中95例吸毒方式为静脉注射吸毒（占75.39％），同时在这组病例中有115例患者有不洁性交史（占91.26％）。结论：海洛因依赖者为梅毒高发人群，静脉吸毒和不洁性交为传播梅毒主要途径，应加强对海洛因依赖者的血清学检测，加强对海洛因依赖者进行减少危害的宣传教育。     

广西河池市美沙酮门诊海洛因依赖人群HIV、HCV、TB、梅毒感染情况调查

目的獉獉:了解河池市美沙酮门诊海洛因依赖人群的特征,HIV、HCV、TB和梅毒感染情况及其危险因素。方法獉獉:对参加美沙酮维持治疗的388名海洛因依赖者进行治疗前的问卷调查,HIV、HCV、TB、梅毒血清学检测及胸部X线摄片检查。结果獉獉:87.11%的海洛因依赖者采用静脉注射方式吸毒,46.15%的静脉吸毒者共用注射器。HIV抗体阳性率7.99%(31/388),其中静脉注射吸毒HIV抗体阳性率8.88%(30/338)。HCV抗体阳性率72.16%(280/388),其中静脉注射吸毒HCV抗体阳性率74.85%(253/338)。TB抗体阳性率0.26%(1/388),梅毒抗体阳性率13.66%(53/388)。结论獉獉:河池市美沙酮门诊海洛因依赖人群,尤其是静脉吸毒者中HCV和梅毒感染较高。在海洛因依赖人群中推广针具交换、安全套免费发放和相关知识的健康教育、行为干预尤为重要。     

海洛因滥用者中22例HIV感染分析

目的··:了解海洛因滥用者HIV感染行为 ,评估海洛因滥用者人群HIV感染的趋势。方法·· :对我院1997年至1999年收治的3015例海洛因依赖者感染HIV的情况进行调查分析。结果··:发现22例 (占0.73 % )海洛因依赖者HIV抗体阳性 ,其中男性19例 (19/2613 ,占0.73 % ) ,女性3例 (3/402 ,占0.75 % );86.36 %(19/22)为静脉注射毒品者 ,静脉注射者中大部分 (89.47 % )有共用注射器具史。72.73 % (16/22)的HIV感染者同时具有性混乱史。结论··:海洛因滥用者是HIV感染的高危人群 ,海洛因滥用者的感染行为主要包括共用注射器具和性混乱行为     

Injection drug use in Calcutta: a potential focus for an explosive HIV epidemic

Our objective was to assess HIV risk perceptions, risk behaviours and factors that may facilitate an increase in injection drug use in Calcutta. Focus group discussions and in-depth interviews were conducted with a selected group of drug users to delineate drug use patterns, languages used to express addictive and related experiences and acceptance of harm minimization messages. Results from these were used to develop a semi-structured interview instrument which was used to interview 111 drug users (76 IDUs and 35 non-IDUs) recruited from jails and detoxification centres. Secondary data of narcotic seizures for the last 5 years were collected from the Calcutta police department. Data on percentage of IDUs admitted to large detox facility in the city was also collected. Findings show that HIV/AIDS knowledge and risk perceptions were low; sharing of injection equipment was reported by 66% of the injectors; and condom use was insignificant. Non-availability, rising cost and increasing tolerance to heroin were cited as factors contributing to switch to injection. Ecological association was found between intensified police activity and an increase in: the amount of smokable heroin seized; increased injection of buprenorphine; and admission to detoxification centres. In addition to HIV, IDUs were also found to be prone to hepatitis B and C. The findings suggest an urgent need for developing and implementing community-based HIV prevention interventions targeting drug users in Calcutta.     

柳州市海洛因依赖者HIV感染初筛结果分析

目的··:了解我市吸毒人群HIV感染的情况。方法 :·· 采用公安部第二研究所提供的艾滋病病毒抗体检验试剂盒(全血 ) ,对在所治疗的270例海洛因依赖者进行抗 -HIV抗体初筛检测。结果·· :在270例受检者中有42例抗 -HIV呈阳性反应 ,占15.56 %。结论··:我市吸毒人群中HIV感染率呈高速发展的态势     

东莞市美沙酮门诊海洛因成瘾者基线调查

目的:了解东莞市美沙酮维持治疗门诊海洛因成瘾者的人口学及行为学特点,为采取进一步干预措施提供依据。方法:采用国家统一的《社区药物维持治疗评估基线调查表》对在东莞市美沙酮维持治疗门诊服药人员进行调查。调查内容包括人口学、行为学及HIV、HCV感染情况等。结果:在东莞市美沙酮维持治疗门诊服药的人员中30a以下者占86·1%;男性占96·0%,已婚占52·7%;初中文化程度占69·2%;无业/待业者占53·2%。与家庭关系良好者占43·8%。过去一个月(调查前)79·6%有注射吸毒行为,28·8%共用针具。64·4%有未婚性行为,多性伴比例占21·0%,61·5%在最近一次性行为中使用了安全套。过去3个月,10·9%曾违法犯罪。无HIV感染者,HCV感染者占30·3%。来门诊单程花费的时间最短2min,最长3h,平均40min±s27·6min。结论:在东莞市美沙酮维持治疗门诊就诊的服药人员主要是青壮年男性,文化程度低,多为无业/待业者;未发现HIV感染者,针具共用率均较低,但存在非婚性行为、多性伴、安全套使用率偏低等感染HIV的高危因素。建议加大对该人群的宣传教育和推广安全套使用等干预措施。     

Opioids and HIV/HCV Infection

Since human immunodeficiency virus (HIV) and hepatitis C virus (HCV) share the same modes of transmission and common risk factors for infection, co-infections with HIV and HCV are frequently found in injection drug users (IDUs). IDUs represent one of the largest reservoirs of HIV as well as HCV in the United States. These two pathogens are also likely to be responsible for the highest infectious disease morbidity and mortality rates among IDUs. IDUs frequently involve the abuse of heroin, the most common abused opiate. Opiates have been suggested to have a cofactor role in the immunopathogenesis of HIV disease, as they have the potential to compromise host immune responses and enhances microbial infections. Although in vitro studies have yielded relatively agreeable data that morphine, the active metabolite of heroin, exacerbate HIV infection/replication, epidemiologic studies as well as in vivo non-human primate investigations on the impact of opiate abuse on HIV disease progression have yielded the conflicting data. Given immunomodulation and immunocompromising effect as well as demonstrated impact to enhance HIV replication in vitro, it is reasonable to believe that opiate abuse is a facilitator in HIV and/or HCV disease progression. However, much remain to be learned about the mechanisms of opiate-mediated broad influence on host immunity and viral expression. Thus, more extensive studies are needed in order to determine the effects of different conditions of opiate abuse and to define the understanding of the role of opiate in modulating HIV and/or HCV disease progression.     

HIV Among Drug Users at Beth Israel Medical Center,New York City,the First 25 Years

New York City experienced the first and largest HIV epidemic among injecting drug users (IDUs). Using data collected from IDUs entering the Beth Israel drug detoxification program, we trace the history of this epidemic from the mid-1970s through the early 2000s. The epidemic can best be described in terms of successive stages: (1) introduction and rapid transmission of HIV in the IDU population; (2) stabilization of HIV prevalence at a high level (over 50%); (3) a decline in incidence and prevalence, following large-scale implementation of syringe exchange programs; and (4) a sexual transmission phase, in which HIV prevalence is approximately equal among injecting and noninjecting heroin and cocaine users, and sexual transmission is more important than injecting-related transmission among IDUs. Given the current spread of HIV among IDUs in many places in the world, New York City provides a very strong example for implementation of large-scale comprehensive syringe exchange programs as early as possible in HIV epidemics among IDUs.     

HIV among drug users at Beth Israel Medical Center, New York City, the first 25 years

New York City experienced the first and largest HIV epidemic among injecting drug users (IDUs). Using data collected from IDUs entering the Beth Israel drug detoxification program, we trace the history of this epidemic from the mid-1970s through the early 2000s. The epidemic can best be described in terms of successive stages: (1) introduction and rapid transmission of HIV in the IDU population; (2) stabilization of HIV prevalence at a high level (over 50%); (3) a decline in incidence and prevalence, following large-scale implementation of syringe exchange programs; and (4) a sexual transmission phase, in which HIV prevalence is approximately equal among injecting and noninjecting heroin and cocaine users, and sexual transmission is more important than injecting-related transmission among IDUs. Given the current spread of HIV among IDUs in many places in the world, New York City provides a very strong example for implementation of large-scale comprehensive syringe exchange programs as early as possible in HIV epidemics among IDUs.