Don Des Jarlais
Don Des Jarlais
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Professor of Epidemiology
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Professional overview
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Dr. Don Des Jarlais is a leader in the fields of AIDS and injecting drug use, and has published extensively on these topics including articles in The New England Journal of Medicine, JAMA, Science, and Nature.
He is active in international research, having collaborated on studies in many different countries. He serves as a consultant to various institutions, including the U.S. Centers for Disease Control and Prevention, the National Institute of Drug Abuse, the National Academy of Sciences, and the World Health Organization.
Dr. Des Jarlais’ research has received numerous awards, including a New York State Department of Health Commissioner’s award for promoting the health of persons who use drugs. He formerly served as avcommissioner for the National Commission on AIDS; as a core group member of the UNAIDS Reference Group on HIV and Injecting Drug Use; and as a member of the President’s Emergency Plan for AIDS Relief (PEPFAR) Scientific Advisory Board.
Dr. Des Jarlais is also an adjunct faculty of psychiatry and preventive medicine at Icahn School of Medicine at Mount Sinai, and guest investigator at Rockefeller University in New York.
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Education
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BA, Behavioral Science, Rice University, Houston, TXPhD, Social Psychology, University of Michigan, Ann Arbor, MI
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Areas of research and study
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EpidemiologyHIV/AIDSPsychology
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Publications
Publications
Hepatitis C virus-specific immune responses in noninjecting drug users
AbstractZeremski, M., Makeyeva, J., Arasteh, K., Des Jarlais, D. C., & Talal, A. H. (n.d.).Publication year
2012Journal title
Journal of Viral HepatitisVolume
19Issue
8Page(s)
554-559AbstractNoninjection drug use, although recognized as an emerging risk factor for acquisition of other blood-born pathogens, is still unconfirmed as a route of hepatitis C virus (HCV) transmission. Our goal was to measure HCV exposure and prevalence in noninjection drug users (NIDUs). Fifty-seven NIDUs were screened by extensive questionnaire to exclude prior injection drug use and evaluated for HCV-specific serologic and cellular immune responses. HCV-specific T-cell responses were measured using interferon-gamma (IFN-Î) enzyme-linked immunospot (ELISpot) assay with overlapping HCV peptides covering the entire HCV genome. Fifteen individuals who never used illicit drugs served as negative controls. Eleven people with no history of injecting drug use (19.3%) were HCV seropositive: seven with chronic HCV infection and four with previously resolved infection. Of 51 NIDUs with ELISpot results, HCV-specific cellular immunity was detected in 5 (9.8%). These responses were relatively weak and narrow. We did not find significant associations between HCV-specific immune responses and noninjection drug use practices. Subjects with HCV-specific immunity, however, were significantly more likely to have bought sex in the past 6 months, to have had more casual partners of the opposite sex in the last 6 months, and those partners were more likely to have ever injected drugs compared to subjects without HCV-specific immunity. In summary, we found serologic or cellular HCV-specific immune responses in 27.5% of NIDUs. Our results suggest that sexual behaviour associated with noninjection drug use might be a risk factor for HCV acquisition. Additional studies are needed to precisely determine the practices that lead to HCV exposure among this population.High dose benzodiazepine dependence: Description of 29 patients treated with flumazenil infusion and stabilised with clonazepam
AbstractQuaglio, G., Pattaro, C., Gerra, G., Mathewson, S., Verbanck, P., Des Jarlais, D. C., & Lugoboni, F. (n.d.).Publication year
2012Journal title
Psychiatry ResearchVolume
198Issue
3Page(s)
457-462AbstractThe withdrawal syndrome from benzodiazepine (BZD) can be severe and in some cases may impede cessation of the use of the drug. We present here a case series of benzodiazepine detoxification by flumazenil infusion, stabilised with clonazepam. Patients were treated with flumazenil 1.35. mg/day for a median of 7. days. Self-reported physical withdrawal symptoms were recorded daily. In addition to flumazenil, antidepressants were given before treatment commenced and clonazepam was administered nightly with both being continued after discharge. Twenty-nine patients were treated. No patients dropped out from the treatment programme. Nine patients (31%) required a temporary reduction/cessation of the infusion. The linear trend in the reduction of the daily withdrawal scores in the overall study population was significant. The linear trends were also significant in the group of patients for whom a temporary reduction/suspension of the flumazenil was required. Six months after treatment, 15 patients (53%) were abstinent from clonazepam and other BZDs. For five (21%) the BZD dependence were reinstated. More than two-thirds of the subjects tolerated the procedure well and about half had a good long term response. Slow flumazenil infusion appears to merit consideration as a possible future treatment. Suggestions for future research are examined.Homeless former smokers' interest in helping homeless current smokers quit
AbstractGoldade, K., Guo, H., Jarlais, D. D., Connett, J. E., Whembolua, G. L., Owen, G., Guy, M., & Okuyemi, K. S. (n.d.).Publication year
2012Journal title
American Journal of Health PromotionVolume
27Issue
2Page(s)
90-93AbstractPurpose. To describe the factors associated with interest of homeless former smokers in helping homeless smokers quit. Methods. A cross-sectional survey administered to an optimized convenience sample of homeless persons (n = 4570) at emergency shelters, transitional housing units, and open encampments in 80 cities across Minnesota. The in-person survey response rate was 90%. Analysis. Chi-square tests and t-tests for univariate analysis. Results. Of 4534 participants completing the smoking questions, 546 participants (12%) self-identified as former smokers, of which 59% expressed interest in helping homeless smokers quit. Significant predictors of reported interest in helping included racial/ethnic background (p < .05), number of people known who had quit smoking (p < .01), and receiving social services as an adult (p < .01). Conclusion. Homeless former smokers are a potential resource for peer support programs to promote smoking cessation among homeless current smokers.Meta-analysis of hepatitis C seroconversion in relation to shared syringes and drug preparation equipment
AbstractPouget, E. R., Hagan, H., & Des Jarlais, D. C. (n.d.).Publication year
2012Journal title
AddictionVolume
107Issue
6Page(s)
1057-1065AbstractAims We conducted a systematic review of studies reporting seroincidence of hepatitis C infection (HCV) in relation to shared syringes and drug preparation equipment among injection drug users (IDUs). We identified published and unpublished studies that met inclusion criteria. Design We estimated the relative contributions of shared syringes and drug preparation equipment to HCV transmission using random-effects meta-analysis, and analyzed potential sources of heterogeneity of effects among studies. Findings Syringe sharing was associated with HCV seroconversion [pooled risk ratio (PRR)=1.94, 95% confidence interval (CI)1.53, 2.46], as was sharing drug preparation containers (PRR=2.42, 95% CI1.89, 3.10), filters (PRR=2.61, 95% CI1.91, 3.56), rinse water (PRR=1.98, 95% CI1.54, 2.56), combinations of this equipment (PRR=2.24, 95% CI1.28, 3.93) and 'backloading', a syringe-mediated form of sharing prepared drugs (PRR=1.86, 95% CI1.41, 2.44). Meta-regression results showed that the association between syringe sharing and seroconversion was modified by HCV seroprevalence in the IDU populations. Conclusions The risk of hepatitis C infection through shared syringes is dependent upon hepatitis C infection seroprevalence in the population. The risk of hepatitis C infection through shared drug preparation equipment is similar to that of shared syringes. Because the infection status of sharing partners is often unknown, it is important for injection drug users to consistently avoid sharing unsterile equipment used to prepare, divide or inject drugs and avoid backloading with an unsterile syringe.Multiple routes of drug administration and HIV risk among injecting drug users
AbstractVorobjov, S., Uusküla, A., Des Jarlais, D. C., Abel-Ollo, K., Talu, A., & Rüütel, K. (n.d.).Publication year
2012Journal title
Journal of Substance Abuse TreatmentVolume
42Issue
4Page(s)
413-420AbstractThis study assesses relationships between drug administration routes and HIV serostatus, drug use, and sexual behaviors among current injecting drug users (IDUs) in Tallinn, Estonia. We recruited 350 IDUs for a cross-sectional risk behavior survey. Adjusted odds ratios (AORs) were calculated to explore injection risk behavior, sexual behavior, and HIV serostatus associated with multiple route use. Focus groups explored reasons why injectors might use non-injecting routes of administration. Those reporting multiple drug administration routes were less likely to be HIV seropositive (AOR = 0.49, 95% confidence interval [CI] = 0.25-0.97) and had almost twice the odds of having more than one sexual partner (AOR = 1.90, 95% CI = 1.01-3.60) and of reporting having sexually transmitted diseases (AOR = 2.38, 95% CI = 1.02-5.59). IDUs who engage in noninjecting drug use may be reducing their risk of acquiring HIV though sharing injection equipment, but if infected may be a critical group for sexual transmission of HIV to people who do not inject drugs.Reply to high-quality meta-analyses are required for development of evidence in medicine
Hagan, H., Des Jarlais, D. C., & Pouget, E. (n.d.). In Journal of Infectious Diseases (1–).Publication year
2012Volume
205Issue
9Page(s)
1473Spatial access to sterile syringes and the odds of injecting with an unsterile syringe among injectors: A longitudinal multilevel study
AbstractCooper, H., Des Jarlais, D., Ross, Z., Tempalski, B., Bossak, B. H., & Friedman, S. R. (n.d.).Publication year
2012Journal title
Journal of Urban HealthVolume
89Issue
4Page(s)
678-696AbstractDespite the 2010 repeal of the ban on spending federal monies to fund syringe exchange programs (SEPs) in the USA, these interventions-and specifically SEP site locations-remain controversial. To further inform discussions about the location of SEP sites, this longitudinal multilevel study investigates the relationship between spatial access to sterile syringes distributed by SEPs in New York City (NYC) United Hospital Fund (UHF) districts and injecting with an unsterile syringe among injectors over time (1995-2006). Annual measures of spatial access to syringes in each UHF district (N=42) were created using data on SEP site locations and site-specific syringe distribution data. Individual-level data on unsterile injecting among injectors (N=4,067) living in these districts, and on individual-level covariates, were drawn from the Risk Factors study, an ongoing cross-sectional study of NYC drug users. We used multilevel models to explore the relationship of district-level access to syringes to the odds of injecting with an unsterile syringe in >75% of injection events in the past 6 months, and to test whether this relationship varied by district-level arrest rates (per 1,000 residents) for drug and drug paraphernalia possession. The relationship between district-level access to syringes and the odds of injecting with an unsterile syringe depended on district-level arrest rates. In districts with low baseline arrest rates, better syringe access was associated with a decline in the odds of frequently injecting with an unsterile syringe (AOR, 0.95). In districts with no baseline syringe access, higher arrest rates were associated with increased odds of frequently injecting with an unsterile syringe (AOR, 1.02) When both interventions were present, arrest rates eroded the protective effects of spatial access to syringes. Spatial access to syringes in small geographic areas appears to reduce the odds of injecting with an unsterile syringe among local injectors, and arrest rates elevate these odds. Policies and practices that curtail syringe flow in geographic areas (e.g., restrictions on SEP locations or syringe distribution) or that make it difficult for injectors to use the sterile syringes they have acquired may damage local injectors' efforts to reduce HIV transmission and other injection-related harms.Transitions from injection-drug-use-concentrated to self-sustaining heterosexual HIV epidemics: Patterns in the international data
AbstractDes Jarlais, D. C., Feelemyer, J. P., Modi, S. N., Arasteh, K., Mathers, B. M., Degenhardt, L., & Hagan, H. (n.d.).Publication year
2012Journal title
PloS oneVolume
7Issue
3AbstractBackground: Injecting drug use continues to be a primary driver of HIV epidemics in many parts of the world. Many people who inject drugs (PWID) are sexually active, so it is possible that high-seroprevalence HIV epidemics among PWID may initiate self-sustaining heterosexual transmission epidemics. Methods: Fourteen countries that had experienced high seroprevalence (<20%) HIV epidemics among PWID and had reliable data for injection drug use (IDU) and heterosexual cases of HIV or AIDS were identified. Graphs of newly reported HIV or AIDS cases among PWID and heterosexuals were constructed to identify temporal relationships between the two types of epidemics. The year in which newly reported cases among heterosexuals surpassed newly reported cases among PWID, aspects of the epidemic curves, and epidemic case histories were analyzed to assess whether it was "plausible" or "highly unlikely" that the HIV epidemic among PWID might have initiated the heterosexual epidemic in each country. Results: Transitions have occurred in 11 of the 14 countries. Two types of temporal relationships between IDU and heterosexual HIV epidemics were identified, rapid high incidence transitions vs. delayed, low incidence transitions. In six countries it appears "plausible" that the IDU epidemic initiated a heterosexual epidemic, and in five countries it appears "highly unlikely" that the IDU epidemic initiated a heterosexual epidemic. A rapid decline in incidence among PWID after the peak year of new cases and national income were the best predictors of the "highly unlikely" initiation of a heterosexual epidemic. Discussion: Transitions from IDU concentrated epidemics to heterosexual epidemics are common in countries with high seroprevalence among PWID though there are distinct types of transitions. Interventions to immediately reduce HIV incidence among PWID may reduce the likelihood that an IDU epidemic may initiate a heterosexual epidemic.Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990-2010: A systematic analysis for the Global Burden of Disease Study 2010
AbstractVos, T., Flaxman, A. D., Naghavi, M., Lozano, R., Michaud, C., Ezzati, M., Shibuya, K., Salomon, J. A., Abdalla, S., Aboyans, V., Abraham, J., Ackerman, I., Aggarwal, R., Ahn, S. Y., Ali, M. K., Almazroa, M. A., Alvarado, M., Anderson, H. R., Anderson, L. M., … Murray, C. J. (n.d.).Publication year
2012Journal title
The LancetVolume
380Issue
9859Page(s)
2163-2196AbstractBackground: Non-fatal health outcomes from diseases and injuries are a crucial consideration in the promotion and monitoring of individual and population health. The Global Burden of Disease (GBD) studies done in 1990 and 2000 have been the only studies to quantify non-fatal health outcomes across an exhaustive set of disorders at the global and regional level. Neither eff ort quantified uncertainty in prevalence or years lived with disability (YLDs). Methods: Of the 291 diseases and injuries in the GBD cause list, 289 cause disability. For 1160 sequelae of the 289 diseases and injuries, we undertook a systematic analysis of prevalence, incidence, remission, duration, and excess mortality. Sources included published studies, case notification, population-based cancer registries, other disease registries, antenatal clinic serosurveillance, hospital discharge data, ambulatory care data, household surveys, other surveys, and cohort studies. For most sequelae, we used a Bayesian meta-regression method, DisMod-MR, designed to address key limitations in descriptive epidemiological data, including missing data, inconsistency, and large methodological variation between data sources. For some disorders, we used natural history models, geospatial models, back-calculation models (models calculating incidence from population mortality rates and case fatality), or registration completeness models (models adjusting for incomplete registration with health-system access and other covariates). Disability weights for 220 unique health states were used to capture the severity of health loss. YLDs by cause at age, sex, country, and year levels were adjusted for comorbidity with simulation methods. We included uncertainty estimates at all stages of the analysis. Findings: Global prevalence for all ages combined in 2010 across the 1160 sequelae ranged from fewer than one case per 1 million people to 350 000 cases per 1 million people. Prevalence and severity of health loss were weakly correlated (correlation coefficient -0·37). In 2010, there were 777 million YLDs from all causes, up from 583 million in 1990. The main contributors to global YLDs were mental and behavioural disorders, musculoskeletal disorders, and diabetes or endocrine diseases. The leading specific causes of YLDs were much the same in 2010 as they were in 1990: low back pain, major depressive disorder, iron-deficiency anaemia, neck pain, chronic obstructive pulmonary disease, anxiety disorders, migraine, diabetes, and falls. Age-specific prevalence of YLDs increased with age in all regions and has decreased slightly from 1990 to 2010. Regional patterns of the leading causes of YLDs were more similar compared with years of life lost due to premature mortality. Neglected tropical diseases, HIV/AIDS, tuberculosis, malaria, and anaemia were important causes of YLDs in sub-Saharan Africa. Interpretation: Rates of YLDs per 100 000 people have remained largely constant over time but rise steadily with age. Population growth and ageing have increased YLD numbers and crude rates over the past two decades. Prevalences of the most common causes of YLDs, such as mental and behavioural disorders and musculoskeletal disorders, have not decreased. Health systems will need to address the needs of the rising numbers of individuals with a range of disorders that largely cause disability but not mortality. Quantification of the burden of non-fatal health outcomes will be crucial to understand how well health systems are responding to these challenges. Eff ective and aff ordable strategies to deal with this rising burden are an urgent priority for health systems in most parts of the world.A systematic review and meta-analysis of interventions to prevent hepatitis C virus infection in people who inject drugs
AbstractHagan, H., Pouget, E. R., & Des Jarlais, D. C. (n.d.).Publication year
2011Journal title
Journal of Infectious DiseasesVolume
204Issue
1Page(s)
74-83AbstractIntroduction. High rates of hepatitis C virus (HCV) transmission are found in samples of people who inject drugs (PWID) throughout the world. The objective of this paper was to meta-analyze the effects of risk-reduction interventions on HCV seroconversion and identify the most effective intervention types. Methods. We performed a systematic review and meta-analysis of published and unpublished studies. Eligible studies reported on the association between participation in interventions intended to reduce unsafe drug injection and HCV seroconversion in samples of PWID. Results. The meta-analysis included 26 eligible studies of behavioral interventions, substance-use treatment, syringe access, syringe disinfection, and multicomponent interventions. Interventions using multiple combined strategies reduced risk of seroconversion by 75% (pooled relative risk, .25; 95% confidence interval, .07-.83). Effects of single-method interventions ranged from .6 to 1.6. Conclusions. Interventions using strategies that combined substance-use treatment and support for safe injection were most effective at reducing HCV seroconversion. Determining the effective dose and combination of interventions for specific subgroups of PWID is a research priority. However, our meta-analysis shows that HCV infection can be prevented in PWID.Associations between herpes simplex virus type 2 and HCV with HIV among injecting drug users in New York City: The current importance of sexual transmission of HIV
AbstractDes Jarlais, D. C., Arasteh, K., McKnight, C., Hagan, H., Perlman, D. C., & Semaan, S. (n.d.).Publication year
2011Journal title
American journal of public healthVolume
101Issue
7Page(s)
1277-1283AbstractObjectives: We examined relationships between herpes simplex virus type 2 (HSV-2), a biomarker for sexual risk, and HCV, a biomarker for injecting risk, with HIV among injecting drug users (IDUs) who began injecting after large-scale expansion of syringe exchange programs in New York City. Methods: We recruited 337 heroin and cocaine users who began injecting in 1995 or later from persons entering drug detoxification. We administered a structured interview covering drug use and HIV risk behavior and collected serum samples for HIV, HCV, and HSV-2 testing. Results: HIV prevalence was 8%, HSV-2 39%, and HCV 55%. We found a significant association between HSV-2 and HIV (odds ratio [OR]=7.9; 95% confidence interval [CI]=2.9, 21.4) and no association between HCV and HIV (OR=1.14; 95% CI=0.5, 2.6). Black IDUs had the highest prevalence of HSV-2 (76%) and HIV (24%) but the lowest prevalence of HCV (34%). Conclusions: Most HIV infections among these IDUs occurred through sexual transmission. The relative importance of injecting versus sexual transmission of HIV may be critical for understanding racial/ethnic disparities in HIV infection.Designing a smoking cessation intervention for the unique needs of homeless persons: A community-based randomized clinical trial
AbstractGoldade, K., Whembolua, G. L., Thomas, J., Eischen, S., Guo, H., Connett, J., Des Jarlais, D., Resnicow, K., Gelberg, L., Owen, G., Grant, J., Ahluwalia, J. S., & Okuyemi, K. S. (n.d.).Publication year
2011Journal title
Clinical TrialsVolume
8Issue
6Page(s)
744-754AbstractBackground Although smoking prevalence remains strikingly high in homeless populations (∼70% and three times the US national average), smoking cessation studies usually exclude homeless persons. Novel evidence-based interventions are needed for this high-risk subpopulation of smokers.Purpose To describe the aims and design of a first-ever smoking cessation clinical trial in the homeless population. The study was a two-group randomized community-based trial that enrolled participants (n = 430) residing across eight homeless shelters and transitional housing units in Minnesota. The study objective was to test the efficacy of motivational interviewing (MI) for enhancing adherence to nicotine replacement therapy (NRT; nicotine patch) and smoking cessation outcomes.Methods Participants were randomized to one of the two groups: active (8 weeks of NRT + 6 sessions of MI) or control (NRT + standard care). Participants attended six in-person assessment sessions and eight retention visits at a location of their choice over 6 months. Nicotine patch in 2-week doses was administered at four visits over the first 8 weeks of the 26-week trial. The primary outcome was cotinine-verified 7-day point-prevalence abstinence at 6 months. Secondary outcomes included adherence to nicotine patch assessed through direct observation and patch counts. Other outcomes included the mediating and/or moderating effects of comorbid psychiatric and substance abuse disorders.Results Lessons learned from the community-based cessation randomized trial for improving recruitment and retention in a mobile and vulnerable population included: (1) the importance of engaging the perspectives of shelter leadership by forming and convening a Community Advisory Board; (2) locating the study at the shelters for more visibility and easier access for participants; (3) minimizing exclusion criteria to allow enrollment of participants with stable psychiatric comorbid conditions; (4) delaying the baseline visit from the eligibility visit by a week to protect against attrition; and (5) regular and persistent calls to remind participants of upcoming appointments using cell phones and shelter-specific channels of communication.Limitations The study's limitations include generalizability due to the sample drawn from a single Midwestern city in the United States. Since inclusion criteria encompassed willingness to use NRT patch, all participants were motivated and were ready to quit smoking at the time of enrollment in the study. Findings from the self-select group will be generalizable only to those motivated and ready to quit smoking. High incentives may limit the degree to which the intervention is replicable.Conclusions Lessons learned reflect the need to engage communities in the design and implementation of community-based clinical trials with vulnerable populations.Drug use, community action, and public Health: Gay men and crystal meth in NYC
AbstractBraine, N., Acker, C. J., Van Sluytman, L., Friedman, S., & Des Jarlais, D. C. (n.d.).Publication year
2011Journal title
Substance Use and MisuseVolume
46Issue
4Page(s)
368-380AbstractIn 2004, GLBT and HIV/AIDS service providers in NYC mobilized against use of crystal methamphetamine among gay men. Both drug use and mobilization were shaped by the history of HIV, particularly the institutions, action repertoires, and social networks forged in earlier AIDS work. This paper is based on qualitative research conducted from 2007 to 2009 with advocates, service providers, and men who have sex with men recruited from diverse venues in NYC gay communities. The crystal use epidemic among gay men in NYC indicates the importance of social and historical context in shaping drug use and antidrug mobilization, including the potential for public health responses to drug use.Expanded syringe exchange programs and reduced HIV infection among new injection drug users in Tallinn, Estonia
AbstractUusküla, A., Des Jarlais, D. C., Kals, M., Rüütel, K., Abel-Ollo, K., Talu, A., & Sobolev, I. (n.d.).Publication year
2011Journal title
BMC public healthVolume
11AbstractBackground: Estonia has experienced an HIV epidemic among intravenous drug users (IDUs) with the highest per capita HIV prevalence in Eastern Europe. We assessed the effects of expanded syringe exchange programs (SEP) in the capital city, Tallinn, which has an estimated 10,000 IDUs. Methods. SEP implementation was monitored with data from the Estonian National Institute for Health Development. Respondent driven sampling (RDS) interview surveys with HIV testing were conducted in Tallinn in 2005, 2007 and 2009 (involving 350, 350 and 327 IDUs respectively). HIV incidence among new injectors (those injecting for < = 3 years) was estimated by assuming (1) new injectors were HIV seronegative when they began injecting, and (2) HIV infection occurred at the midpoint between first injection and time of interview. Results: SEP increased from 230,000 syringes exchanged in 2005 to 440,000 in 2007 and 770,000 in 2009. In all three surveys, IDUs were predominantly male (80%), ethnic Russians (>80%), and young adults (mean ages 24 to 27 years). The proportion of new injectors decreased significantly over the years (from 21% in 2005 to 12% in 2009, p = 0.005). HIV prevalence among all respondents stabilized at slightly over 50% (54% in 2005, 55% in 2007, 51% in 2009), and decreased among new injectors (34% in 2005, 16% in 2009, p = 0.046). Estimated HIV incidence among new injectors decreased significantly from 18/100 person-years in 2005 and 21/100 person-years in 2007 to 9/100 person-years in 2009 (p = 0.026). Conclusions: In Estonia, a transitional country, a decrease in the HIV prevalence among new injectors and in the numbers of people initiating injection drug use coincided with implementation of large-scale SEPs. Further reductions in HIV transmission among IDUs are still required. Provision of 70 or more syringes per IDU per year may be needed before significant reductions in HIV incidence occur.Global epidemiology of hepatitis B and hepatitis C in people who inject drugs: Results of systematic reviews
AbstractNelson, P. K., Mathers, B. M., Cowie, B., Hagan, H., Des Jarlais, D., Horyniak, D., & Degenhardt, L. (n.d.).Publication year
2011Journal title
The LancetVolume
378Issue
9791Page(s)
571-583AbstractInjecting drug use is an important risk factor for transmission of viral hepatitis, but detailed, transparent estimates of the scale of the issue do not exist. We estimated national, regional, and global prevalence and population size for hepatitis C virus (HCV) and hepatitis B virus (HBV) in injecting drug users (IDUs). We systematically searched for data for HBV and HCV in IDUs in peer-reviewed databases (Medline, Embase, and PsycINFO), grey literature, conference abstracts, and online resources, and made a widely distributed call for additional data. From 4386 peer-reviewed and 1019 grey literature sources, we reviewed 1125 sources in full. We extracted studies into a customised database and graded them according to their methods. We included serological reports of HCV antibodies (anti-HCV), HBV antibodies (anti-HBc), or HBV surface antigen (HBsAg) in studies of IDUs with more than 40 participants (<100 HIV-positive) and sampling frames that did not exclude participants on the basis of age or sex. With endorsed decision rules, we calculated prevalence estimates with anti-HCV and anti-HBc as proxies for exposure and HBsAg as proxy for current infection. We combined these estimates with IDU population sizes to calculate the number of IDUs with positive HBV or HCV statuses. We located eligible reports with data for prevalence of anti-HCV in IDUs for 77 countries; midpoint prevalence estimates suggested 60-80 of IDUs had anti-HCV in 25 countries and more than 80 of IDUs did so in 12 countries. About 10.0 million (range 6.0-15.2) IDUs worldwide might be anti-HCV positive. China (1.6 million), USA (1.5 million), and Russia (1.3 million) had the largest such populations. We identified eligible HBsAg reports for 59 countries, with midpoint prevalence estimates of 5-10 in 21 countries and more than 10 in ten countries. Worldwide, we estimate 6.4 million IDUs are anti-HBc positive (2.3-9.7 million), and 1.2 million (0.3-2.7 million) are HBsAg positive. More IDUs have anti-HCV than HIV infection, and viral hepatitis poses a key challenge to public health. Variation in the coverage and quality of existing research creates uncertainty around estimates. Improved and more complete data and reporting are needed to estimate the scale of the issue, which will inform efforts to prevent and treat HCV and HBV in IDUs.HIV among drug users at beth israel medical center, new york city, the first 25 years
AbstractDes Jarlais, D. C., Arasteh, K., & Friedman, S. R. (n.d.).Publication year
2011Journal title
Substance Use and MisuseVolume
46Issue
2Page(s)
131-139AbstractNew York City experienced the first and largest HIV epidemic among injecting drug users (IDUs). Using data collected from IDUs entering the Beth Israel drug detoxification program, we trace the history of this epidemic from the mid-1970s through the early 2000s. The epidemic can best be described in terms of successive stages: (1) introduction and rapid transmission of HIV in the IDU population; (2) stabilization of HIV prevalence at a high level (over 50%); (3) a decline in incidence and prevalence, following large-scale implementation of syringe exchange programs; and (4) a sexual transmission phase, in which HIV prevalence is approximately equal among injecting and noninjecting heroin and cocaine users, and sexual transmission is more important than injecting-related transmission among IDUs. Given the current spread of HIV among IDUs in many places in the world, New York City provides a very strong example for implementation of large-scale comprehensive syringe exchange programs as early as possible in HIV epidemics among IDUs.Induction of CXCR3- and CCR5-associated chemokines during acute hepatitis C virus infection
AbstractZeremski, M., Hooker, G., Shu, M. A., Winkelstein, E., Brown, Q., Des Jarlais, D. C., Tobler, L. H., Rehermann, B., Busch, M. P., Edlin, B. R., & Talal, A. H. (n.d.).Publication year
2011Journal title
Journal of HepatologyVolume
55Issue
3Page(s)
545-553AbstractBackground & Aims: Characterization of inflammatory mediators, such as chemokines, during acute hepatitis C virus (HCV) infection might shed some light on viral clearance mechanisms. Methods: Plasma levels of CXCR3 (CXCL9-11)- and CCR5 (CCL3-4)-associated chemokines, ALT, and HCV RNA were measured in nine injection drug users (median 26 samples/patient) before and during 10 acute (eight primary and two secondary) HCV infections. Using functional data analysis, we estimated smooth long-term trends in chemokine expression levels to obtain the magnitude and timing of overall changes. Residuals were analyzed to characterize short-term fluctuations. Results: CXCL9-11 induction began 38-53 days and peaked 72-83 days after virus acquisition. Increases in ALT levels followed a similar pattern. Substantial negative auto-correlations of chemokine levels at 1 week lags suggested substantial week-to-week oscillations. Significant correlations were observed between CXCL10 and HCV RNA as well as ALT and CXCR3-associated chemokines measured in the preceding week, CCL3-4 expression levels did not change appreciably during acute HCV infection. Conclusions: Elevation of CXCR3-associated chemokines late during acute HCV infection suggests a role for cellular immune responses in chemokine induction. Week-to-week oscillations of HCV RNA, chemokines, and ALT suggest frequent, repeated cycles of gain and loss of immune control during acute hepatitis C.Quality of care in patients with chronic hepatitis C virus infection
Talal, A. H., Perlman, D. C., & Des Jarlais, D. C. (n.d.). In Annals of internal medicine (1–).Publication year
2011Volume
154Issue
3Page(s)
213Role of sexual transmission of HIV among young noninjection and injection opiate users: A respondent-driven sampling study
AbstractLi, J., Liu, H., Li, J., Luo, J., Des Jarlais, D., & Koram, N. (n.d.).Publication year
2011Journal title
Sexually Transmitted DiseasesVolume
38Issue
12Page(s)
1161-1166AbstractBackground: Sexual transmissibility of HIV among young drug users in China has been investigated in few studies. The objective of this study was to examine the role of sexual transmission on HIV infection among injection drug users (IDUs) and noninjection drug users (NIDUs). Methods: Respondent-driven sampling (RDS) was used to recruit 426 young heroin/opium drug users in Yunnan, China. Logistic regression modeling was performed to examine interrelationships among risky sexual behaviors, drug-use modes, and drug-use practices. Results: Substantial proportions of NIDUs and IDUs reported engagement in risky sexual behaviors including: (1) multiple sexual partners (42% of NIDUs vs. 37% of IDUs), (2) concurrent sexual partnerships (48% vs. 46%), (3) commercial sex partners (23% vs. 24%), and sex partners who were NIDUs (14% vs. 17%). Both NIDUs and IDUs reported low levels of condom use with nonregular partners (48% vs. 42%) and regular partner (24% vs. 27%), and having a history of recent methamphetamine use (21% vs. 18%). Compared to IDUs, NIDUs reported having had fewer sex partners who were IDUs, fewer IDU network peers, more NIDU network peers, and having lower levels of HIV knowledge and self-perceived HIV risk. Conclusions: Generalization of the HIV epidemic from high-risk groups to the general population may be driven by risky sexual behavior among drug users. Reducing sexual transmission of HIV among both IDUs and NIDUs is the next major challenge for HIV intervention among drug users in China.Sexual contexts and the process of risk reduction
AbstractBraine, N., Van Sluytman, L., Acker, C., Friedman, S., & Des Jarlais, D. C. (n.d.).Publication year
2011Journal title
Culture, Health and SexualityVolume
13Issue
7Page(s)
797-814AbstractUnderstanding the dynamics of sexual risks for HIV among men who have sex with men has been one of the ongoing challenges of HIV prevention. While the majority of HIVprevention interventions target individual behaviour and decision making, multiple studies point to the importance of social context in shaping risk behaviour. Analysis of qualitative data from a study of men who have sex with men, drug use and sex found that sexual encounters were made up multiple contextual and interpersonal elements, which interacted to shape sexual practices and risk reduction strategies. Semi-structured interviews were conducted with 60 racially diverse men who have sex with men in NYC, recruited from multiple venues. The majority of respondents were gay-identified and half were 40 or older. Respondents described risk assessment and risk-reduction processes that develop throughout a sexual encounter, embedded in ongoing negotiations of sexual practices. Strategies of risk assessment and reduction draw on probabilitybased approaches to HIV prevention, presenting a challenge to health education.Spatial access to syringe exchange programs and pharmacies selling over-the-counter syringes as predictors of drug injectors' use of sterile syringes
AbstractCooper, H. L., Des Jarlais, D. C., Ross, Z., Tempalski, B., Bossak, B., & Friedman, S. R. (n.d.).Publication year
2011Journal title
American journal of public healthVolume
101Issue
6Page(s)
1118-1125AbstractObjectives: We examined relationships of spatial access to syringe exchange programs (SEPs) and pharmacies selling over-the-counter (OTC) syringes with New York City drug injectors' harm reduction practices. Methods: Each year from 1995 to 2006, we measured the percentage of 42 city health districts' surface area that was within 1 mile of an SEP or OTC pharmacy. We applied hierarchical generalized linear models to investigate relationships between these exposures and the odds that injectors (n=4003) used a sterile syringe for at least 75% of injections in the past 6 months. Results: A 1-unit increase in the natural log of the percentage of a district's surface area within a mile of an SEP in 1995 was associated with a 26% increase in the odds of injecting with a sterile syringe; a 1-unit increase in this exposure over time increased these odds 23%. A 1-unit increase in the natural log of OTC pharmacy access improved these odds 15%. Conclusions: Greater spatial access to SEPs and OTC pharmacies improved injectors' capacity to engage in harm reduction practices that reduce HIV and HCV transmission.Symbiotic goals and the prevention of blood-borne viruses among injection drug users
AbstractFriedman, S. R., Sandoval, M., Mateu-Gelabert, P., Meylakhs, P., & Des Jarlais, D. C. (n.d.).Publication year
2011Journal title
Substance Use and MisuseVolume
46Issue
2Page(s)
307-315AbstractA positive-deviance control-case life history study of injection drug users (IDUs) in New York City who had injected drugs for 8-15 years compared 21 IDUs who were antibody negative for both HIV and hepatitis C with 3 infected with both viruses and 11 infected with hepatitis C virus but not HIV. Eligible subjects were referred from other research studies and from community organizations that conduct testing for HIV and hepatitis C virus. Data were collected during 2005-2008 and were analyzed using life history and grounded theory approaches. They support grounded hypotheses that IDUs who are able to attain symbiotic goals like avoiding withdrawal and maintaining social support are assisted thereby in remaining uninfected with HIV or hepatitis C. These hypotheses should be tested using cohort studies and prevention trials to see if helping IDUs attain symbiotic goals reduces infection risk. The study's limitations are noted.Buprenorphine in maintenance treatment: Experience among italian physicians in drug addiction centers
AbstractQuaglio, G., Pattaro, C., Gerra, G., Mezzelani, P., Montanari, L., Jarlais, D. C., & Lugoboni, F. (n.d.).Publication year
2010Journal title
American Journal on AddictionsVolume
19Issue
3Page(s)
222-230AbstractThe aim of this study was to assess the attitudes of Italian physicians regarding buprenorphine and its clinical use approximately 6 years after the medication was introduced into clinical practice. The sample consisted of 305 randomly selected physicians, working in public centers of drug addiction. In Italy buprenorphine seems a valid tool in the field of drug addiction treatment, although it is far from replacing methadone even though it seems to guarantee better compliance. Interviewees follow clinical experience more than international guidelines, with pharmaceutical company representatives as the most cited source for information about the medication. The data also suggests a need for the development of formal guidelines for treatment with buprenorphine in Italy.Emergent properties of HIV risk among injection drug users in Tallinn, Estonia: synthesis of individual and neighbourhood-level factors.
AbstractUusküla, A., McMahon, J. M., Raag, M., Silm, S., Rüütel, K., Talu, A., Abel-Ollo, K., Ahas, R., & Des Jarlais, D. C. (n.d.).Publication year
2010Journal title
Sexually transmitted infectionsVolume
86Page(s)
iii79-84AbstractHIV/AIDS risk is embodied within multiple levels including structural and social levels. The aim of this study was to assess the effects of neighbourhood characteristics on HIV prevalence among injection drug users (IDU) residing in the area of Tallinn, Estonia in 2007. A cross-sectional, multilevel design collecting individual-level data--a behaviour survey including data on self-reported residency and HIV antibody testing among 350 IDU and neighbourhood-level data--aggregate measures on socio-demo-economic residential characteristics from the 2000 Estonian census. Geocoding and multilevel modelling analysis was employed. Among the 350 IDU recruited, earlier age at first injection, fentanyl as the main injection drug, receptive syringe sharing, main income source other than legal employment and ever attended a syringe exchange programme remained significantly associated with increased odds of anti-HIV positivity in the multivariable analysis involving individual effects with no predictors at the neighbourhood level. In the multilevel model, individual (earlier at IDU initiation AOR 1.86, 95% CI 1.01 to 3.44; injecting opioids AOR 4.43, 95% CI 2.74 to 7.18; receptive syringe sharing AOR 2.51, 95% CI 1.86 to 3.37; main income source other than work AOR 2.04, 95% CI 1.32 to 3.14; ever attended a syringe exchange programme AOR 2.58, 95% CI 1.83 to 3.61) and neighbourhood level (higher unemployment rate AOR 5.95, 95% CI 2.47 to 14.31; greater residential change AOR 1.89, 95% CI 1.09 to 3.26) emerged as significant predictors of individual HIV-positive status. Our results indicate that both individual-level and emergent neighbourhood-level factors contribute to HIV risk among IDU and are amenable for preventive interventions.Ethical considerations in surveys employing respondent-driven sampling
Semaan, S., Heckathorn, D. D., Des Jarlais, D. C., & Garfein, R. S. (n.d.). In American journal of public health (1–).Publication year
2010Volume
100Issue
4Page(s)
582-583