Detection of HIV-1 in Injection Paraphernalia: Risk in an Era of Heightened Awareness

Abstract

Links between AIDS and self-injection of drugs were first recognized more than 20 years ago, but identification of a specific pathogen and ways to neutralize it has not led to complete success in preventing transmission of HIV-1 infection among injecting drug users (IDUs). A street ethnographer identified active risk locales (places where IDUs go to inject drugs) and recruited their proprietors into a study of contaminated injection paraphernalia. Collected paraphernalia from locales were analyzed for contamination by HIV-1 using real-time polymerase chain reaction (PCR). Proprietors and clientele of 16 risk locales participated by contributing used paraphernalia and/or agreeing to a blood test (0.5-1 mL drawn by finger stick). Realtime PCR was the primary measure used to determine contamination of injection paraphernalia and blood samples with HIV-1. Of 130 samples collected at baseline, a total of 8 were found to have evidence of HIV-1 contamination by detection of either HIV-1 RNA or DNA. The most serious contamination (up to 600,000 copies per milliliter) was found in ancillary paraphernalia, rather than needle/syringe (N/S) specimens. Only 4 of 74 N/S specimens had any evidence of HIV-1 contamination at all (with very low viral loads), and none had both HIV-1 DNA and RNA. Although IDUs in risk locales in Miami/Dade appear to be taking care of their N/S with regard to contamination by HIV-1, important evidence of contamination in ancillary paraphernalia, especially cookers and cottons, indicates that IDUs may still incur serious risk regardless of how well they care for their N/S. Our observations indicated that IDUs rinsed their N/S before returning them to the proprietors, from whom we eventually collected them, and this rinsing would have masked the contamination to which they were exposed through use of unrinsed cookers and reused cottons.

Depressive Symptoms, Substance Use, and HIV-Related High-Risk Behaviors Among Opioid-Dependent Individuals: Results From the Clinical Trials Network

“…First, drug abusers are more likely to engage in sexual risk behaviors than non-drug abusers (Brewer, Zhao, Metsch, Coltes, & Zenilman, 2007; Neaigus, Miller, Friedman, & Des Jarlais, 2001; Steffanie A. Strathdee & Sherman, 2003). Second, injection drug users (IDUs) often engage in injection risk behaviors, such as sharing needles with fellow IDUs without cleaning them with bleach (Des Jarlais, Braine, Yi, & Turner, 2007; Page et al, 2006), and some non-IDUs are at high risk of progressing to injection drug use (Arria, Fuller, Strathdee, Latkin, & Vlahov, 2002; Fuller et al, 2002; Sherman et al, 2005), thus increasing their risk of becoming HIV-infected.…”

Predictors of Sharing Injection Equipment by HIV-Seropositive Injection Drug Users

“…Many countries report injection drug use (IDU) as the primary mode of HIV transmission 1–3. In some countries, IDUs have reported reductions in syringe sharing; however, many IDUs continue to share syringes despite high levels of HIV knowledge and a higher proportion report sharing other types of injection equipment used in the drug preparation process, such as cookers, cotton, and rinse water 4,5. In addition to the health concern of transmitting HIV, a large proportion of injectors, especially HIV positive IDUs, are co-infected with hepatitis C (HCV), which is readily transmitted through the sharing of injection equipment 6…”

Molecular and Contextual Markers of Hepatitis C Virus and Drug Abuse

“…Despite the implementation of needle exchange, however, shared and re-used N/S, cottons, cookers, and wash-waters continue to contribute significantly to the spread of HCV, as well as HIV-1. [9,30,55,57,[68][69][70][71][72][73][74][75][76][77] Many social or behavioral markers are identified; however, it is laboratory studies that are needed to translate markers into quantitative laboratory tests.…”