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. 2013;8(3):e59125.
doi: 10.1371/journal.pone.0059125. Epub 2013 Mar 18.

Drug users in Amsterdam: are they still at risk for HIV?

Nienke van der Knaap  1 , Bart P X Grady, Maarten F Schim van der Loeff, Titia Heijman, Arjen Speksnijder, Ronald Geskus, Maria Prins
Affiliations

Drug users in Amsterdam: are they still at risk for HIV?

Nienke van der Knaap et al. PLoS One. 2013.

Abstract

Background and aims: To examine whether drug users (DU) in the Amsterdam Cohort Study (ACS) are still at risk for HIV, we studied trends in HIV incidence and injecting and sexual risk behaviour from 1986 to 2011.

Methods: The ACS is an open, prospective cohort study on HIV. Calendar time trends in HIV incidence were modelled using Poisson regression. Trends in risk behaviour were modelled via generalized estimating equations. In 2010, a screening for STI (chlamydia, gonorrhoea and syphilis) was performed. Determinants of unprotected sex were studied using logistic regression analysis.

Results: The HIV incidence among 1298 participants of the ACS with a total follow-up of 12,921 person-years (PY) declined from 6.0/100 PY (95% confidence interval [CI] 3.2-11.1) in 1986 to less than 1/100 PY from 1997 onwards. Both injection and sexual risk behaviour declined significantly over time. Out of 197 participants screened for STI in 2010-2011, median age 49 years (IQR 43-59), only 5 (2.5%) were diagnosed with an STI. In multivariable analysis, having a steady partner (aOR 4.1, 95% CI 1.6-10.5) was associated with unprotected sex. HIV-infected participants were less likely to report unprotected sex (aOR 0.07, 95% CI 0.02-0.37).

Conclusions: HIV incidence and injection risk behaviour declined from 1986 onwards. STI prevalence is low; unprotected sex is associated with steady partners and is less common among HIV-infected participants. These findings indicate a low transmission risk of HIV and STI, which suggests that DU do not play a significant role in the current spread of HIV in Amsterdam.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Observed and fitted HIV incidence in the Amsterdam Cohort Studies among drug users (DU), for all DU and for injecting DU only, 1986–2011.
The shaded and striped areas represent the 95% confidence intervals for, respectively, all DU (fitted) and injecting DU only (fitted).
Figure 2
Figure 2. Fitted trends in self-reported injecting and sexual risk behaviour of proportion of visits per calendar year among DU of the Amsterdam Cohort Studies, 1986–2011.
The shaded and striped and grey areas represent the 95% confidence intervals. STI, sexual transmitted infection.
See this image and copyright information in PMC

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