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  • 1
    Electronic Resource
    Electronic Resource
    Methadone maintenance and cessation of injecting drug use: results from the Amsterdam Cohort Study (2000)
    Oxford, UK : Carfax Publishing, Taylor & Francis Ltd
    Addiction 95 (2000), S. 0 
    Details
    ISSN: 1360-0443
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine , Psychology
    Notes: Aims. To assess relationships between characteristics of methadone maintenance treatment and long-term cessation of injecting (\〉= 1 year). Design and participants. The incidence of cessation of injecting and relapse from non-injecting to injecting was estimated among 488 participants of the Amsterdam cohort study among drug users. We used a nested matched case–control design to identify methadone treatment characteristics significantly and independently related to cessation of injecting. To ensure detailed and valid assessment of methadone treatment, data of the Central Methadone Register were linked with cohort data. For 339 of 488 subjects of the initial study group methadone data were available. Findings. The incidence of cessation of injecting increased from 2.2 /100 person years in 1985–89 to 5.5 /100 per year in 1995–97 (p trend = 0.005). Relapse to injecting was high: 17.2 /100 person years (no trend). Methadone dosage and frequency of methadone programme attendance in themselves were not significantly related to cessation of injecting. However, an individual increase of 5 mg or more per year (OR 4.20, 95% CI 1.54–11.46) and receiving methadone mainly via the outpatient clinic for drug-abusing prostitutes and foreigners (OR 0.18, 95% CI 0.05–0.59) were independent predictors of cessation of injecting. After cessation of injecting, there were no HIV-seroconversions during the period of non-injecting (129 person years). After relapse to injecting there was one seroconverter; however, follow-up was small (23 person years). The HIV-incidence of those who continued injecting was 3.2 /100 per year. Conclusions. Steadily increasing the methadone dosage in a harm reduction setting may be useful in supporting injecting drug users in the process of cessation of injecting and reducing the spread of HIV-infection.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1046/j.1360-0443.2000.95459110.x
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  • 2
    Electronic Resource
    Electronic Resource
    RESEARCH REPORT Differentiation in the Amsterdam dispensing circuit: determinants of methadone dosage and site of methadone prescription methadone (1998)
    Oxford, UK : Carfax Publishing Limited
    Addiction 93 (1998), S. 0 
    Details
    ISSN: 1360-0443
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine , Psychology
    Notes: Abstract Aims. To evaluate the Methadone Dispensing Circuit in Amsterdam by identifying determinants of methadone dosage and client characteristics in the different types of methadone programmes. Design and participants. Four hundred and forty-four participants of a cohort study of drug users in Amsterdam who had consented to link data of the Central Methadone Register to the cohort data. Findings. From 1985 to 1994, methadone dosage increased from 41 to 59 mg/day. The mean methadone dosage was higher for ethnic West Europeans, Germans, older drug users, HIV-positive drug users, those with a longer duration of prostitution, current injectors, those with a longer duration of injecting, longer duration of methadone use, higher frequency of being dispensed methadone and clients of the prostitutes' and foreigners' outpatient clinic. For clients of the general practitioner, at the police station and in prison the methadone dosage was lower. We found different sets of client characteristics in those receiving methadone at the methadone outpost, the methadone bus, the prostitutes' and foreigners' outpatient clinic, the general practitioner and the outdoor addiction clinic. Conclusions. These results indicate that the Amsterdam system is highly differentiated in a way that is largely concordant with the intended general policy on methadone treatment.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1046/j.1360-0443.1998.931617.x
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  • 3
    Electronic Resource
    Electronic Resource
    Young and recent-onset injecting drug users are at higher risk for HIV (1997)
    Oxford, UK : Blackwell Publishing Ltd
    Addiction 92 (1997), S. 0 
    Details
    ISSN: 1360-0443
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine , Psychology
    Notes: Aims. To determine whether young or recent-onset injecting drug users (IDUs) are at increased risk of HIV infection, and to compare trends in risk behaviours and HIV incidence among subgroups of IDUs. Design. Associations of age and onset of injecting with HIV prevalence and injecting risk behaviours were determined among current IDUs who entered an Amsterdam cohort between 1989 and 1995, and compared with current IDUs recruited in two street surveys in 1990 and 1993. In the cohort, trends from 1986 through 1995 in injecting risk behaviour (as reported at entry) and in HIV seroconversion (among current IDUs during follow-up) were determined using logistic and Poisson regression. Findings. Sizable portions of IDUs were young (≤ 25 years: 14–30%) or had recently started injecting (within the last 3 years: 17–21%). Between 37% and 50% of young IDUs recently started injecting. HIV prevalence was 12–24% among young IDUs, and 5–12% among recent-onset IDUs. Young IDUs more often reported current borrowing than older IDUs. Borrowing declined significantly in all subgroups, except young IDUs. The crude HIV incidence declined from 18/100 person-years (PY) in 1986 to 5/100 PY in 1995. Trends in HIV incidence were not significantly different for subgroups of age or onset of injecting. In a multivariate analysis, recent onset of injecting was an independent predictor (p = 0.04) for HIV seroconversion, but age was not (p = 0.68). Conclusions. Important proportions of drug users are young or have recently started injecting. HIV prevalence is relatively high among young and recent-onset IDUs. Recent onset of injection is an independent predictor for HIV seroconversion. Our observations may be explained by non-random patterns of borrowing used needles/syringes. Recent-onset IDUs should be approached more actively for HIV counselling and testing.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1360-0443.1997.tb02867.x
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  • 4
    Electronic Resource
    Electronic Resource
    Continuing injecting risk behaviour: results from the Amsterdam Cohort Study of drug users (1999)
    Oxford, UK : Carfax Publishing, Taylor & Francis Ltd
    Addiction 94 (1999), S. 0 
    Details
    ISSN: 1360-0443
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine , Psychology
    Notes: Aims. To give a detailed description of injection-related risk behaviours, and to estimate the relative importance of these behaviours with regard to HIV transmission. Design. The present study was part of the Amsterdam Cohort Study of drug users. Setting. In Amsterdam, a city with extensive preventive measures, large HIV-risk reductions have taken place, but no further decreases have occurred since 1991. Participants and measurements. A detailed questionnaire on injecting risk behaviour was completed by a cross-section of participants in 1992/93 (n = 168). Among 48 HIV-seroconverters, a questionnaire was completed concerning possible HIV-transmission route. Findings. Of 96 HIV-negative participants, 23% deliberately borrowed a used syringe, 18% reported possible "accidental" borrowing, 9% front/backloading, 4% simultaneous injection, and 32% possible sharing of ancillary equipment. Of deliberate borrowers, 64% borrowed from a person with unknown or positive HIV serostatus, and 81% did not appropriately clean the equipment; 79% borrowed in the absence of serious withdrawal symptoms. Risk factors differed for deliberate and 'accidental' borrowing. Among the HIV seroconverters, the most likely transmission route was borrowing in 29% of cases, front/backloading in 8%, borrowing or front/backloading in 21%, unprotected sexual contact in 23% (mainly with regular partner) and either injecting or sexual risk in 13%. Women were much more likely to report sexual transmission ( p = 0.016). Borrowing was admitted by 43% before, and 64% after awareness of HIV-seroconverion. Conclusions. As the injecting risk is high, usually deliberate, and often in the absence of withdrawal symptoms, further prevention seems difficult. Although deliberate borrowing is the main risk for HIV seroconversion, unprotected sexual contacts and front- and backloading may be more important than previously thought in Amsterdam. Under-reporting of borrowing is probably substantial, but does not alter the above conclusions.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1046/j.1360-0443.1999.947105110.x
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  • 5
    Electronic Resource
    Electronic Resource
    Increased cell division but not thymic dysfunction rapidly affects the T-cell receptor excision circle content of the naive T cell population in HIV-1 infection (2000)
    [s.l.] : Nature America Inc.
    Nature medicine 6 (2000), S. 1036-1042 
    Details
    ISSN: 1546-170X
    Source: Nature Archives 1869 - 2009
    Topics: Biology , Medicine
    Notes: [Auszug] Recent thymic emigrants can be identified by T cell receptor excision circles (TRECs) formed during T-cell receptor rearrangement. Decreasing numbers of TRECs have been observed with aging and in human immunodeficiency virus (HIV)-1 infected individuals, suggesting thymic impairment. Here, we show ...
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1038/79549
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  • 6
    Electronic Resource
    Electronic Resource
    Do Today's Young Homosexual Men Practice Safer Sex Than Today's Older Homosexual Men Did When They Were Young? An Analysis of Sexual Behavior Change Across Cohorts in Amsterdam (1999)
    Springer
    Aids and behavior 3 (1999), S. 75-81 
    Details
    ISSN: 1573-3254
    Keywords: HIV/AIDS ; young men ; homosexual men ; sexual risk behavior ; STD
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Comparisions of the level of sexual risk taking of today's younger and older homosexual men have not provided unequivocal conclusions regarding whether younger homosexual men are at higher risk than their older counterparts. To appraise more fully the level of risk taking among young homosexual men, this study also emphasizes a comparison of young homosexual men today with their older counterparts when they were young. Information from the Amsterdam Cohort Study and the Amsterdam Young Gay Men's Study was used to provide data on HIV and STD prevalence as well as sexual behavior among younger (≤30 years) and older (〉30 years) homosexual men in 1984/85 and 1995/96. Overall prevalence of HIV and STDs has dropped considerably among young gay men since 1984/85. Levels of unprotected receptive anal intercourse have also declined across time (from 98% to less than 48%), with 37% now restricting this practice to one partner. Direct behavioral comparisons between younger and older homosexual men might provide a ‘high-risk’ image for young gay men. However, when young homosexual men today are compared with their older counterparts when they were younger, a substantial reduction in high-risk sexual behavior across time is observed.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1023/A:1025423620577
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  • 7
    Electronic Resource
    Electronic Resource
    The HIV prevalence among pregnant women in the Amsterdam region (1988–1991) (1994)
    Springer
    European journal of epidemiology 10 (1994), S. 331-338 
    Details
    ISSN: 1573-7284
    Keywords: Abortion ; HIV ; Pregnancy ; Women
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The objective of the study was to monitor the HIV prevalence in the years 1988–1991 among pregnant women in the Amsterdam region, visitors to an abortion clinic and 3 outpatient infertility clinics. All women attending these clinics were asked to participate in the study on a voluntary basis and were tested with informed consent. The women were questioned about risk-bearing behaviour of themselves and their sexual partner(s). In the period 1988–1991, of the 23,827 eligible pregnant women, 22,165 women participated (93.0%). Twenty-seven women were found to be positive for HIV antibodies (0.12%, 95% CI: 0.08%–0.17%), of whom twenty belonged to a known HIV risk group or had a partner who belonged to one of these groups and 7 women had no known HIV risk. Seventeen of the 27 women had a foreign nationality. The annual HIV prevalence among pregnant women was: 1988: 0.28%; 1989: 0.10%; 1990: 0.10%; 1991: 0.11%. In the years 1990 and 1991, of the 1,128 eligible women visiting the abortion clinic 953 (84.5%) were tested. Eleven women were HIV-seropositive (1.15%, 95% CI: 0.6%–2.0%), of whom 9 were from an AIDS endemic region, 1 woman had a partner from this region and 1 woman had no known HIV risk. Four African women had HIV-2 antibodies. At the 3 outpatient infertility clinics 1 woman was found to be HIV-positive (0.13%; 95% CI: 0.02–0.9). She had no other risk than a partner from an AIDS endemic area. In the Amsterdam region there was a steady and low HIV prevalence (0.1%) among pregnant women through the years 1988–1991. The prevalence in the abortion clinic was ten times higher. The program was able to detect possible high risk groups within the population. Migration and travelling can play an important role in the spread of HIV in the general heterosexual population.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01719358
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  • 8
    Electronic Resource
    Electronic Resource
    Methods for estimating HIV prevalence: A comparison of extrapolation from surveys on infection rate and risk behaviour with back-calculation for the Netherlands (1998)
    Springer
    European journal of epidemiology 14 (1998), S. 645-652 
    Details
    ISSN: 1573-7284
    Keywords: AIDS ; Back-calculation ; Exposure group ; HIV ; Methodology ; Prevalence
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objectives: To compare HIV prevalence estimates (total number infected) by using extrapolation from surveys on infection rate and risk behaviour (EIR) in specific segments of the population and back-calculation (BC) on reported AIDS cases. To discuss potential sources of bias and error, and to identify areas for improvement of the methodology. Design: Systematic comparison and epidemiological assessment of data input, underlying assumptions, and output. Methods: Low, possibly unbiased and high estimates of HIV prevalence as of January 1996 for homo/bisexual men, injecting drug users, heterosexual men and women with multiple partners, and blood transfusion recipients and haemophiliacs were derived from surveys and continuous data collections on HIV infection rate and risk behaviour in the Netherlands between 1992 and 1996. These were compared with estimates (point and 95% CI) by empirical Bayesian BC on AIDS cases 1982–1995. Results and conclusions: The estimate of HIV prevalence by EIR was 13,806 with low and high estimates of 9619 and 17,700, respectively. The HIV prevalence estimate by BC was 8812 (95% CI: 7759–9867). The available data from EIR are too limited for accurate estimates of HIV prevalence. EIR estimates could be improved considerably with more precise data on prevalence of risk behaviours and HIV prevalence rate for homosexual men. More confidence can be put in the BC estimates, but these could be underestimates because of the age effect on incubation time, pre-AIDS treatment and relapse of risk behaviour. BC estimates could be improved by a better representation of the incubation time distribution (including the effect of age thereupon), better data on the effectiveness and uptake of pre-AIDS antiretroviral treatment and prophylaxis of opportunistic infections, and on the level of underreporting.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1023/A:1007495607520
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  • 9
    Electronic Resource
    Electronic Resource
    Estimating the size of the HIV epidemic among injecting drug users in Amsterdam (1997)
    Springer
    European journal of epidemiology 13 (1997), S. 261-265 
    Details
    ISSN: 1573-7284
    Keywords: AIDS incidence ; Estimation ; HIV-1 ; HIV prevalence ; Injecting drug users ; Mortality
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Aim of this study was to assess the cumulative incidence of HIV-infection, AIDS and pre-AIDS death in the population of injecting drug users (IDU) in Amsterdam. By assuming equivalence, between a cohort of IDU and the IDU population, of the ratios of incidences of AIDS and pre-AIDS death to the number of HIV positive persons giving rise to these incidences, the numbers of HIV positive persons and pre-AIDS deaths in the population could be calculated, given that other parameters were known. Cohort study data on HIV prevalence and incidences of HIV infection, AIDS, and pre-AIDS death, were combined with national AIDS surveillance data. As of 1 October 1994, the estimated cumulative number of HIV positive IDU in Amsterdam was approximately 1280, far higher than a recent back-calculation estimate. Of the 1280, 204 HIV positive IDU had been diagnosed with AIDS, while about 270 had died pre- AIDS. The HIV prevalence of IDU residing in Amsterdam that were still alive and free of AIDS was hence estimated at around 800. Since the incidence of pre-AIDS death and AIDS exceeded the number of seroconversions during the past four years, the HIV epidemic among IDU in Amsterdam appears to be dwindling. A lower bound of the number of HIV positive IDU being alive, AIDS-free and living elsewhere in the Netherlands was roughly estimated at 600. Because of untimely deaths, only a limited number of HIV positive IDU can be expected to be diagnosed with AIDS in the future. Since these estimates are based upon some rather bold assumptions, they should be interpreted with caution and require further validation by independent sources.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1023/A:1007346800071
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  • 10
    Electronic Resource
    Electronic Resource
    Gender differences in clinical manifestations before AIDS diagnosis among injecting drug users (1998)
    Springer
    European journal of epidemiology 14 (1998), S. 213-218 
    Details
    ISSN: 1573-7284
    Keywords: Gender ; Human immunodeficiency virus (HIV) ; Injecting drug use ; Symptoms
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract We compared incidence rates of self-reported HIV-related symptoms and illnesses, verified clinical manifestations and findings on physical examination between female and male injecting drug users (IDU) stratified by HIV serostatus in the Amsterdam cohort study on the natural history of HIV infection. HIV-positive female IDU (n = 100) reported a higher frequency of several symptoms and illnesses than male IDU (n = 139). Symptoms were reported more chronically by women compared to men, while clinical manifestations were reported by a greater proportion of women affected by these illnesses compared to men. In HIV-negative IDU (163 women and 232 men) the incidence rates were lower compared to HIV-positives, and a similar gender effect on reported symptoms and illnesses was found. Adjusting for biological, behavioral, demographic and study related variables did not change the gender effect on clinical manifestations substantially. We conclude that the gender effect among HIV-positive IDU was not caused by a differential impact of HIV infection on the incidence of the studied clinical manifestations among female and male IDU, but reflects a higher morbidity of female IDU compared to male IDU.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1023/A:1007416920420
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