Drug Users in Amsterdam: Are They Still at Risk for HIV?

Abstract

Background and AimsTo 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.MethodsThe 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.ResultsThe 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).ConclusionsHIV 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.

Increase in recreational drug use between 2008 and 2018: results from a prospective cohort study among HIV‐negative men who have sex with men

“…In addition, previous reports have shown very low and even decreasing IDU over time in the Netherlands, which probably reflects changes in drug culture and drug market. [51,52] The increases over time in RDU parallel those in CAS and STI previously found in our cohort: the percentage engaging in CAS with a casual partner increased from 27% in 2009 to 39% in 2017, while the incidence rate for any bacterial STI increased from 16.8 per 100 person-years (PY) in 2010 to 33.1 per 100 PY in 2017. [37] This is of concern, given the associations between RDU and HIV/STI observed in our study.…”

“…In addition, previous reports have shown very low and even decreasing IDU over time in the Netherlands, which probably reflects changes in drug culture and drug market. [ 51 , 52 ]…”

Translational HIV-1 research: from routine diagnostics to new virology insights in Amsterdam, the Netherlands during 1983-2013

“…The Amsterdam Cohort Studies on HIV/AIDS (ACS) were started in October 1984, initially as a two-year prospective study of HIV incidence in MSM [30,31], then as an open, prospective cohort study on HIV. Later, DUs were also included in this cohort, but the HIV-1 incidence in drug users has declined steadily in the Netherlands from 1986 onwards to less than 1.0/100 person-years in 2010 with no new seroconversions after 2009 [32,33]. From 2003-2010, adult patients with primary HIV-1 infection (PHI) from 13 Dutch treatment centres were recruited in a cohort study coordinated by the AMC to analyse the effect of early cART treatment on disease progression [34].…”