Multiple routes of drug administration and HIV risk among injecting drug users

Vorobjov, Sigrid; Uusküla, Anneli; Jarlais, Don C. Des; Abel-Ollo, Katri; Talu, Ave

doi:10.1016/j.jsat.2011.09.014

Cited by 9 publications

(11 citation statements)

References 31 publications

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“…Emergency care (i.e in the case of drug overdose) is free and covered for everyone in need irrespective of the health insurance status. It is important to note, however, that studies conducted in Estonia among IDUs found less than 50% health insurance coverage in this group (Vorobjov et al, 2012). The EHIF database was used to construct a data source of people who received treatment related to the use of opioids ( International Classification of Diseases , tenth edition (ICD-10) codes F11.0-F11.9) and a separate data source of people who had an opioid overdose requiring emergency care (ICD-10 T40.0, T40.1, T40.2) from 2005 to 2009.…”

Section: Methodsmentioning

confidence: 92%

“…The IDU status in the EHIF and Death registry capture sources were defined using ICD-10 classification codes for opiate use, in an attempt to identify injection drug users as specifically as possible (Papoz et al, 1996). According to published data, opioids (home-made opioids, heroin or fentanyl/analogues) are the main group of illicit drug used (Vorobjov et al, 2012) and administration other than by injection is rare. Further, the proportion of IDUs injecting only stimulants (rather than opioids) is less than 8% according to a series of cross-sectional studies conducted in Tallinn from 2005–9 that used respondent-driven sampling (Uusküla et al, 2008; Vorobjov et al, 2012; Uusküla A unpublished data), and deaths related to stimulant use have contributed less than 7% of the total of drug-related deaths in Estonia (Tuusov et al, 2012).…”

Section: Discussionmentioning

confidence: 99%

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A decline in the prevalence of injecting drug users in Estonia, 2005–2009

Uusküla

Rajaleid

Talu

et al. 2013

International Journal of Drug Policy

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Aims and setting Descriptions of behavioural epidemics have received little attention compared with infectious disease epidemics in Eastern Europe. Here we report a study aimed at estimating trends in the prevalence of injection drug use between 2005 and 2009 in Estonia. Design and methods The number of injection drug users (IDUs) aged 15–44 each year between 2005 and 2009 was estimated using capture-recapture methodology based on 4 data sources (2 treatment data bases: drug abuse and non-fatal overdose treatment; criminal justice (drug related offences) and mortality (injection drug use related deaths) data). Poisson log-linear regression models were applied to the matched data, with interactions between data sources fitted to replicate the dependencies between the data sources. Linear regression was used to estimate average change over time. Findings there were 24305, 12292, 238, 545 records and 8100, 1655, 155, 545 individual IDUs identified in the four capture sources (Police, drug treatment, overdose, and death registry, accordingly) over the period 2005 – 2009. The estimated prevalence of IDUs among the population aged 15–44 declined from 2.7% (1.8–7.9%) in 2005 to 2.0% (1.4–5.0%) in 2008, and 0.9% (0.7–1.7%) in 2009. Regression analysis indicated an average reduction of over 1700 injectors per year. Conclusion While the capture-recapture method has known limitations, the results are consistent with other data from Estonia. Identifying the drivers of change in the prevalence of injection drug use warrants further research.

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Section: Methodsmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 99%

A decline in the prevalence of injecting drug users in Estonia, 2005–2009

Uusküla

Rajaleid

Talu

et al. 2013

International Journal of Drug Policy

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“…The median age of the 88 PWID was 30 years old (IQR 25-33) and for controls 29 years old (IQR [25][26][27][28][29][30][31][32][33]. Of the PWID and controls, 72 (82%) and 39 (83%), respectively, were male.…”

Section: Characteristics Of the Study Populationmentioning

confidence: 99%

“…Similar to other Eastern European PWID groups, the intravenous drug user (IDU) population in Estonia has high rate of HIV, HBV, and or HCV coinfections and a high percentage of opioid users (14,15,29,31). We have shown that HIV exposure increases CD45RA + RO + T cell percentages and immune activation among an Estonian PWID population (14); however, how the seropositivity of individuals with all three infections (HIV, HBV, and HCV) affects T cell distribution has thus far been seldom studied.…”

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confidence: 99%

T Cell Distribution in Relation to HIV/HBV/HCV Coinfections and Intravenous Drug Use

et al. 2016

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Intravenous drug use (IDU) is one of the most important transmission routes for blood borne viruses, including human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV). These infections alter the subset distributions of T cells; however, knowledge of such effects during HIV, HBV, and or HCV coinfection is limited. Therefore, we aimed to evaluate any associations between T cell distribution and the presence of HIV, HBV, and HCV coinfections among persons who inject drugs (PWID). Blood samples from 88 Caucasian PWID (mean age 30; 82% male) and 47 age-matched subjects negative for all three infections (mean age of 29; 83% male) were analyzed. The T cell markers CD3, CD4, CD8, CD45RA, CCR7, HLA-DR, and CCR5 were assessed using flow cytometry. Of the PWID, 40% were HIV+HBV+HCV+, 20% HBV+HCV+, 19% HCV+, and 13% negative for all three infections. The HIV+HBV+HCV+ PWID had lower percentages of CD4 + and higher percentages of CD8 + cells compared to triple negative PWID ( p < 0.001 in all cases). The only difference between HBV+HCV+ with triple negative PWID was the lower CD4 + cell percentages among the former (52.1% and 58.6%, p = 0.021). Triple negative PWID had higher immune activation and number of CCR5+ cells compared to the controls. We suggest that the altered T cell subset distribution among PWID is mainly triggered by HIV infection and or IDU, while HBV and or HCV seropositivity has minimal additional effects on CD4 + cell distribution.

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“…Drug use is highly criminalized; (“Act on Narcotic Drugs and Psychotropic Substances and Precursors,” 1997) over two thirds of PWID have been imprisoned at least once during their lifetime. (Abel-Ollo, et al, 2009; Uuskula, et al, 2010; Vorobjov, Uuskula, et al, 2012)…”

Section: Estoniamentioning

confidence: 99%

An international perspective on using opioid substitution treatment to improve hepatitis C prevention and care for people who inject drugs: Structural barriers and public health potential

Perlman

Jordan

Uusküla

et al. 2015

International Journal of Drug Policy

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People who inject drugs (PWID) are central to the hepatitis C virus (HCV) epidemic. Opioid substitution treatment (OST) of opioid dependence has the potential to play a significant role in the public health response to HCV by serving as an HCV prevention intervention, by treating non-injection opioid dependent people who might otherwise transition to non-sterile drug injection, and by serving as a platform to engage HCV infected PWID in the HCV care continuum and link them to HCV treatment. This paper examines programmatic, structural and policy considerations for using OST as a platform to improve the HCV prevention and care continuum in 3 countries—the United States, Estonia and Viet Nam. In each country a range of interconnected factors affects the use OST as a component of HCV control. These factors include 1) that OST is not yet provided on the scale needed to adequately address illicit opioid dependence, 2) inconsistent use of OST as a platform for HCV services, 3) high costs of HCV treatment and health insurance policies that affect access to both OST and HCV treatment, and 4) the stigmatization of drug use. We see the following as important for controlling HCV transmission among PWID: 1) maintaining current HIV prevention efforts, 2) expanding efforts to reduce the stigmatization of drug use, 3) expanding use of OST as part of a coordinated public health approach to opioid dependence, HIV prevention, and HCV control efforts, 4) reductions in HCV treatment costs and expanded health system coverage to allow population level HCV treatment as prevention and OST as needed. The global expansion of OST and use of OST as a platform for HCV services should be feasible next steps in the public health response to the HCV epidemic, and is likely to be critical to efforts to eliminate or eradicate HCV.

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Multiple routes of drug administration and HIV risk among injecting drug users

Cited by 9 publications

References 31 publications

A decline in the prevalence of injecting drug users in Estonia, 2005–2009

A decline in the prevalence of injecting drug users in Estonia, 2005–2009

T Cell Distribution in Relation to HIV/HBV/HCV Coinfections and Intravenous Drug Use

An international perspective on using opioid substitution treatment to improve hepatitis C prevention and care for people who inject drugs: Structural barriers and public health potential

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