Clinical Associate Professor of Epidemiology
Dr. Kamyar Arasteh’s research concerns the epidemiology of HIV infection and hepatitis, and the associated sexual and drug use risk factors. The goals of this interdisciplinary and international collaborative effort encompass harm reduction at the individual level, reducing the incidence of infections at the population level, and enhancing treatment among vulnerable groups and in countries that have a high burden of disease.
Examples of previous and ongoing work include research projects in geographically diverse locations, such as New York, Estonia, and Vietnam. A cornerstone of these investigations has been the use of rigorous research methods. Developing and improving research methods, with particular attention to quantitative techniques, continues to be an important focus of this work.
BA, Psychology, Marshall University, Huntington, WVMA, Psychology, Marshall University, Huntington, WVPhD, Psychology, Texas A&M University, College Station, TXPostdoctoral Fellow, Johns Hopkins University School of Medicine, Baltimore, MD
Drug addictionEpidemiologyHarm reductionHepatitisHIV/AIDS
A Multistage Process Model of How a Person Who Currently Injects Drugs Comes to Assist Persons Who Do not Inject with Their First Injections
Hypertension, diabetes and poverty among Latinx immigrants in New York City: implications for COVID-19
Prevalence of Comorbidities and Risks Associated with COVID-19 Among Black and Hispanic Populations in New York City: an Examination of the 2018 New York City Community Health Survey
Self-reported Hazardous Drinking, Hypertension, and Antihypertensive Treatment Among Hispanic Immigrants in the US National Health Interview Survey, 2016–2018
The methamphetamine epidemic among persons who inject heroin in Hai Phong, Vietnam
Using large-scale respondent driven sampling to monitor the end of an HIV epidemic among persons who inject drugs in Hai Phong, Viet Nam
Associations between methamphetamine use and lack of viral suppression among a cohort of HIV-positive persons who inject drugs in Hai Phong, VietnamFailed generating bibliography.Abstract
Page(s)1875-1882AbstractObjective: We assessed the association between methamphetamine use and lack of viral suppression among a cohort of HIV-seropositive persons who inject drugs (PWID) in Hai Phong, Vietnam. Design: Cohort study with random effects logit modeling and mediation analysis for antiretroviral therapy (ART) adherence. Methods: PWID were recruited from October 2016 to October 2017; HIV-seropositive PWID were enrolled in a cohort to assess HIV viral loads, changes in drug use, risk behaviors, and ART adherence during 24-month follow-up. Methamphetamine use in last 30 days was divided into three categories: 0 days (no use), 1 – 19 days (intermediate), and 20 or more days (heavy). Bivariate and a multivariable random effects logit models were used to assess the relationship between methamphetamine use and not being virally suppressed. We also assessed self-reported ART adherence as a mediating factor. Results: A total of 645 HIV-seropositive PWID were included at baseline; 95% male, average age 40 (SD ¼ 6.4). At baseline, methamphetamine use in last 30 days was 64% no use, 32% intermediate use, 4% heavy use. Approximately 74% of PWID reported high/complete adherence; 76% were at viral suppression. In random effects analysis, recent methamphetamine use was associated with not being virally suppressed during follow-up (adjusted odds ratio: 1.84, 95% confidence interval: 1.06, 3.17); the effect was not explained by a mediating effect of self-reported adherence to ART. Conclusion: Recent methamphetamine use is associated with not being virally suppressed among PWID. The results of this study indicate the need for targeted interventions for methamphetamine use with special focus on those with HIV infection.
Ending an HIV epidemic among persons who inject drugs in a middle-income country: Extremely low HIV incidence among persons who inject drugs in Hai Phong, Viet Nam
Expansion of syringe service programs in the United States, 2015-2018
Hepatitis C incidence and prevalence among Puerto Rican people who use drugs in New York CityArasteh, K., Des Jarlais, D. C., Feelemyer, J., & McKnight, C.
Journal titleGlobal Public Health
Page(s)1789-1799AbstractBackground: Hepatitis C virus (HCV) infection is associated with substantial morbidity and mortality among people who use drugs (PWUD). Health disparities related to race/ethnicity and immigration status also increase the risk of HCV infection and decrease the probability of linkage to care. Effective, curative treatment is now available for HCV infection and, alongside prevention, may eliminate HCV epidemics. Methods: We examined HCV incidence, prevalence and associated risk factors among 5459 Puerto Rican (both PR-born and U.S.-born) and non-Puerto Rican (only U.S.-born) entrants to Mount Sinai Beth Israel drug treatment programs in New York City, from August 2005 to January 2018, to assess the need for HCV screening, prevention and treatment in this population. Results: HCV incidence and prevalence among Puerto Rican PWUD was significantly greater than the non-Puerto Ricans PWUD. Among people who inject drugs (PWID), there was no difference in injection risk behaviours by ethnicity/birth place. Conclusions: Findings suggest HCV treatment is a necessary component of a strategy to eliminate HCV epidemics among PWUD. Findings also underline the interconnectedness of epidemics across regions, such that to eliminate the HCV epidemic in one location may depend on eliminating the HCV epidemics in other locations.
HIV control programs reduce HIV incidence but not HCV incidence among people who inject drugs in HaiPhong, Vietnam
Geographic distribution of risk ("Hotspots") for HIV, HCV, and drug overdose among persons who use drugs in New York City: The importance of local historyDes Jarlais, D. C., McKnight, C., Arasteh, K., Feelemyer, J., Ross, Z., & Cooper, H. L.
Journal titleHarm Reduction Journal
Issue1AbstractAims: To identify geographic "hotspots" for potential transmission of HIV and HCV and for drug overdose among persons who use heroin and cocaine in New York City and to examine historical continuities in problem drug use hotspots in the city. Methods: A total of 2714 study participants were recruited among persons entering Beth Israel substance use treatment programs. A structured questionnaire was administered and blood samples for HIV and HCV testing were collected. Hotspots for potential virus transmission were defined as ZIP codes with 10+ participants, 2+ persons infected with the virus and engaging in transmission behavior, and 2+ persons not infected and engaging in acquisition behavior. ZIP codes with 3+ persons with previous overdoses were considered potential hotspots for future overdoses. Results: Participants resided in 166/178 (93%) of the ZIP codes in New York City. Injecting drug use was reported in 150/178 (84%) of the ZIP codes. No zip codes were identified for injecting-related HIV transmission, 5 zip codes were identified for sexual HIV transmission, 3 for HCV transmission, and 8 for drug overdose. Many of the ZIP code potential hotspots were in neighborhoods long associated with drug use: Lower Eastside and Harlem in Manhattan, the South Bronx, and Central Brooklyn. Discussion: Heroin and cocaine use requiring treatment were reported from almost all ZIP codes in New York City, indicating needs for widely dispersed harm reduction services. Identified hotspots should be targeted for reducing sexual transmission of HIV, transmission of HCV, and drug overdoses. Some of the hotspots have persisted as problem drug use areas for 40 to over 100 years. Monitoring of drug use patterns in historical hotspot neighborhoods may permit early identification of and response to emerging drug use-related health problems. Persistent historical hotspots for problem drug use present a complex problem for implementing harm reduction services that deserve additional research.
Implementing an Updated “Break the Cycle” Intervention to Reduce Initiating Persons into Injecting Drug Use in an Eastern European and a US “opioid epidemic” SettingDes Jarlais, D., Uuskula, A., Talu, A., Barnes, D. M., Raag, M., Arasteh, K., Org, G., Demarest, D., Feelemyer, J., Berg, H., & Tross, S.
Journal titleAIDS and Behavior
Page(s)2304-2314AbstractWe tested the hypothesis that an updated “Break the Cycle” (BtC) intervention, based in social cognitive theory and motivational interviewing, would reduce the likelihood that current persons who inject drugs (PWID) would assist persons who do not inject drugs (non-PWID) with first injections in Tallinn, Estonia and Staten Island, New York City. 402 PWID were recruited, a baseline interview covering demographics, drug use, and assisting non-PWID with first drug injections was administered, followed by BtC intervention. 296 follow-up interviews were conducted 6 months post-intervention. Percentages assisting with first injections declined from 4.7 to 1.3% (73% reduction) in Tallinn (p < 0.02), and from 15 to 6% (60% reduction) in Staten Island (p < 0.05). Persons assisted with first injections declined from 11 to 3 in Tallinn (p = 0.02) and from 32 to 13 in Staten Island. (p = 0.024). Further implementation research on BtC interventions is urgently needed where injecting drug use is driving HIV/HCV epidemics and areas experiencing opioid epidemics.
Injection and Heterosexual Risk Behaviors for HIV Infection Among Non-gay Identifying Men Who Have Sex with Men and WomenArasteh, K., Des Jarlais, D. C., McKnight, C., & Feelemyer, J.
Journal titleAIDS and Behavior
Page(s)3315-3323AbstractNon-gay identifying men who have sex with men and women (MSMW) are an important subgroup of men who have sex with men (MSM) and have been underrepresented in studies of MSM that only use gay venues to draw their samples. We assessed heterosexual and drug use risks of MSMW who use drugs in a sample of male entrants to the Mount Sinai Beth Israel drug treatment programs from 2005 to 2018. Blood samples were collected and tested for HIV and HSV-2 infections. Among HIV seronegative participants, MSMW had significantly greater odds of sharing used needles with others, and reporting unprotected sex with female casual partners and female commercial sex partners, compared to their counterparts who reported sex with women exclusively (MSWE). Although not recruited from gay venues, MSMW had a significantly higher HIV prevalence than MSWE (23% vs. 10%, p < 0.001). Interventions that are specifically tailored to HIV prevention among MSMW are needed to ameliorate the prevalence of HIV risks and infection.
Prescription opiate analgesics, heroin, HIV and HCV among persons who inject drugs in New York City, 2016-2018Des Jarlais, D. C., Arasteh, K., McKnight, C., Feelemyer, J., Perlman, D. C., & Tross, S.
Journal titleDrug and alcohol dependence
Volume204AbstractObjectives: Assess relationships among non-medical use of prescription opioid analgesics (POAs), heroin use, and HIV and hepatitis C (HCV) infection among persons who inject drugs (PWID) in New York City, 2016–2018. Methods: PWID (N = 134) were recruited from Mount Sinai Beth Israel drug treatment programs. HIV seropositive persons were oversampled. A questionnaire was administered, and serum samples were collected for HIV and HCV testing. Analyses were stratified by HIV serostatus and compared those who had used POAs to those who had not used POAs. Results: Among the participants, 97% reported injecting heroin, 44% reported injecting cocaine, and 47% reported smoking crack cocaine in the 6 months prior to the interview. There were 66% who reported oral non-medical use of POAs, with 42% using oral POAs in the previous 6 months. There was a clear historical pattern in median year of first injection for different groups: HIV seropositive persons (1985), HIV seronegative persons who never used POAs (1999), and HIV seronegative persons who used POAs (2009). By the time of interview (2016–2018), however, almost all participants (97%) reported injecting heroin. All PWID who reported using POAs also reported injecting heroin. Conclusions: Non-medical POA use among PWID was very common and should not be considered a separate drug use epidemic, but as an additional component of the continuing heroin/poly-drug use epidemic, itself a part of the syndemic of opioid use, stimulant use, overdose, HCV and HIV occurring in New York City.
Hepatitis C virus prevalence and estimated incidence among new injectors during the opioid epidemic in New York City, 2000–2017: Protective effects of non-injecting drug useDes Jarlais, D. C., Arasteh, K., Feelemyer, J., McKnight, C., Barnes, D. M., Perlman, D. C., Uuskula, A., Cooper, H. L., & Tross, S.
Journal titleDrug and alcohol dependence
Page(s)74-79AbstractObjective: Assess hepatitis C virus (HCV) prevalence and incidence among person who began injecting drugs during the opioid epidemic in New York City (NYC) and identify possible new directions for reducing HCV infection among persons who inject drugs. Methods: 846 persons who began injecting drugs between 2000 and 2017 were recruited from persons entering Mount Sinai Beth Israel substance use treatment programs. A structured interview was administered and HCV antibody testing conducted. Protective effects of non-injecting drug use were examined among persons who “reversed transitioned” to non-injecting drug use and persons who used non-injected heroin in addition to injecting. Results: Participants were 79% male, 41% White, 15% African-American, 40% Latinx, with a mean age of 35. Of those who began injecting in 2000 or later, 97 persons (11%) “reverse transitioned” back to non-injecting drug use. Reverse transitioning was strongly associated with lower HCV seroprevalence (30% versus 47% among those who continued injecting, p < 0.005). Among those who continued injecting, HCV seropositivity was inversely associated with current non-injecting heroin use (AOR = 0.72, 95%CI 0.52-0.99). HCV incidence among persons continuing to inject was estimated as 13/100 person-years. HCV seropositive persons currently injecting cocaine were particularly likely to report behavior likely to transmit HCV. Conclusions: Similar to other locations in the US, NYC is experiencing high rates of HCV infection among persons who have begun injecting since 2000. New interventions that facilitate substitution of non-injecting for injecting drug use and that reduce transmission behavior among HCV seropositives may provide additional methods for reducing HCV transmission.
Heterosexual male and female disparities in HIV infection at the end of an epidemic: HIV infection among persons who inject drugs in New York City, 2001–2005 and 2011–2015Des Jarlais, D. C., McKnight, C., Feelemyer, J., Arasteh, K., Tross, S., Campbell, A. N., Cooper, H. L., & Perlman, D. C.
Journal titleDrug and alcohol dependence
Page(s)391-397AbstractBackground: We examined whether sex disparities (heterosexual male:female) in HIV infection continue to persist at the “end of the HIV epidemic” among persons who inject drugs (PWID) in New York City (NYC). An “end of the epidemic” was operationally defined as 1) prevalence of untreated HIV infection <5%, and 2) estimated HIV incidence <0.5/100 person-years. Methods: PWID were recruited from persons entering substance use treatment programs at Mount Sinai Beth Israel in 2001–2005 and 2011–2015. A structured interview was administered, and HIV and HSV-2 testing was conducted. Incidence was estimated using newly diagnosed cases of HIV. Disparity analyses compared prevalence of HIV, of untreated HIV, HIV risk behaviors, and estimated HIV incidence. Results: By 2011–2015, both heterosexual male and female PWID met the two criteria for an “end of the epidemic,” and there were no significant differences in the prevalence of untreated HIV infection. A large sex difference remained in estimated HIV incidence. In 2013–2015, estimated HIV incidence was 2.8/10,000 PY for males and 7.1/10,000 PY for females. Females had greater risk for HIV on several factors. Conclusion: While NYC has reached an “end of the epidemic” for both heterosexual male and female PWID, sex disparities persist, particularly differences in HIV incidence. Eliminating the sex disparities may require a greater focus on factors associated with sexual transmission.
Increased Methamphetamine Use among Persons Who Inject Drugs in Hai Phong, Vietnam, and the Association with Injection and Sexual Risk Behaviors
Potential geographic "hotspots" for drug-injection related transmission of HIV and HCV and for initiation into injecting drug use in New York city, 2011-2015, with implications for the current opioid epidemic in the USDes Jarlais, D. C., Cooper, H. L., Arasteh, K., Feelemyer, J., McKnight, C., & Ross, Z.
Journal titlePloS one
Issue3AbstractObjective We identified potential geographic “hotspots” for drug-injecting transmission of HIV and hepatitis C virus (HCV) among persons who inject drugs (PWID) in New York City. The HIV epidemic among PWID is currently in an “end of the epidemic” stage, while HCV is in a continuing, high prevalence (> 50%) stage. Methods We recruited 910 PWID entering Mount Sinai Beth Israel substance use treatment programs from 2011–2015. Structured interviews and HIV/ HCV testing were conducted. Residential ZIP codes were used as geographic units of analysis. Potential “hotspots” for HIV and HCV transmission were defined as 1) having relatively large numbers of PWID 2) having 2 or more HIV (or HCV) seropositive PWID reporting transmission risk—passing on used syringes to others, and 3) having 2 or more HIV (or HCV) seronegative PWID reporting acquisition risk—injecting with previously used needles/syringes. Hotspots for injecting drug use initiation were defined as ZIP codes with 5 or more persons who began injecting within the previous 6 years. Results Among PWID, 96% injected heroin, 81% male, 34% White, 15% African-American, 47% Latinx, mean age 40 (SD = 10), 7% HIV seropositive, 62% HCV seropositive. Participants resided in 234 ZIP codes. No ZIP codes were identified as potential hotspots due to small numbers of HIV seropositive PWID reporting transmission risk. Four ZIP codes were identified as potential hotspots for HCV transmission. 12 ZIP codes identified as hotspots for injecting drug use initiation. Discussion For HIV, the lack of potential hotspots is further validation of widespread effectiveness of efforts to reduce injecting-related HIV transmission. Injecting-related HIV transmission is likely to be a rare, random event. HCV prevention efforts should include focus on potential hotspots for transmission and on hotspots for initiation into injecting drug use. We consider application of methods for the current opioid epidemic in the US.
Risk behaviors for hiv and hcv infection among people who inject drugs in hai phong, viet nam, 2014
Using dual capture/recapture studies to estimate the population size of persons who inject drugs (PWID) in the city of Hai Phong, Vietnam
Decline in herpes simplex virus type 2 among non-injecting heroin and cocaine users in New York City, 2005 to 2014: Prospects for avoiding a resurgence of human immunodeficiency virusDes Jarlais, D. C., Arasteh, K., Feelemyer, J., McKnight, C., Tross, S., Perlman, D. C., Campbell, A. N., Hagan, H., & Cooper, H. L.
Journal titleSexually Transmitted Diseases
Page(s)85-90AbstractBackground: Herpes simplex virus type 2 (HSV-2) infection increases both susceptibility to and transmissibility of human immunodeficiency virus (HIV), and HSV-2 and HIV are often strongly associated in HIV epidemics. We assessed trends in HSV-2 prevalence among non-injecting drug users (NIDUs) when HIV prevalence declined from 16% to 8% among NIDUs in New York City. Methods: Subjects were current non-injecting users of heroin and/or cocaine and who had never injected illicit drugs. Three thousand one hundred fifty-seven NIDU subjects were recruited between 2005 and 2014 among persons entering Mount Sinai Beth Israel substance use treatment programs. Structured interviews, HIV, and HSV-2 testing were administered. Change over time was assessed by comparing 2005 to 2010 with 2011 to 2014 periods. Herpes simplex virus type 2 incidence was estimated among persons who participated in multiple years. Results: Herpes simplex virus type 2 prevalence was strongly associated with HIV prevalence (odds ratio, 3.9; 95% confidence interval, 2.9-5.1) from 2005 to 2014. Herpes simplex virus type 2 prevalence declined from 60% to 56% (P = 0.01). The percentage of NIDUs with neither HSV-2 nor HIVinfection increased from37% to 43%, (P < 0.001); the percentagewith HSV-2/HIV coinfection declined from 13% to 6% (P < 0.001). Estimated HSV-2 incidence was 1 to 2/100 person-years at risk. Conclusions: There were parallel declines in HIV and HSV-2 among NIDUs in New York City from 2005 to 2014. The increase in the percentage of NIDUs with neither HSV-2 nor HIV infection, the decrease in the percentage with HSV-2/HIV coinfection, and the low to moderate HSV-2 incidence suggest some population-level protection against resurgence of HIV. Prevention efforts should be strengthened to end the combined HIV/HSV-2 epidemic among NIDUs in New York City.
Decline in HSV-2 among non-injecting Heroin and Cocaine users in New York City, 2005-2014: potential protection against HIV resurgenceDes Jarlais, D., Arasteh, K., Feelemyer, J., Mcknight, C., Tross, S., Perlman, D., Campbell, A. N. C., Hagan, H., & Cooper, H. L. F.
Journal titleSexually Transmitted Diseases
Racial/ethnic disparities at the end of an HIV epidemic: Persons who inject drugs in New York City, 2011-2015Des Jarlais, D. C., Arasteh, K., McKnight, C., Feelemyer, J., Tross, S., Perlman, D., Friedman, S., & Campbell, A.
Journal titleAmerican journal of public health
Page(s)1157-1163AbstractObjectives. To examine whether racial/ethnic disparities persist at the "end of the HIV epidemic" (prevalence of untreated HIV infection < 5%; HIV incidence < 0.5 per 100 person-years) among persons who inject drugs (PWID) in New York City. Methods.We recruited 2404 PWID entering New York City substance use treatment in 2001 to 2005 and 2011 to 2015. We conducted a structured interview, and testing for HIV and herpes simplex virus 2 (HSV-2; a biomarker for high sexual risk). We estimated incidence by using newly diagnosed cases of HIV. Disparity analyses compared HIV, untreated HIV, HIV-HSV-2 coinfection, HIV monoinfection, and estimated HIV incidence among Whites, African Americans, and Latinos. Results. By 2011 to 2015, Whites, African Americans, and Latino/as met both criteria of our operational "end-of-the-epidemic" definition. All comparisons that included HIV-HSV-2-coinfected persons had statistically significant higher rates of HIV among racial/ethnic minorities. No comparisons limited to HIV monoinfected persons were significant. Conclusions. "End-of-the-epidemic" criteria were met among White, African American, and Latino/a PWID in New York City, but elimination of disparities may require a greater focus on PWID with high sexual risk.
What happened to the HIV epidemic among non-injecting drug users in New York City?Des Jarlais, D. C., Arasteh, K., McKnight, C., Feelemyer, J., Campbell, A. N., Tross, S., Cooper, H. L., Hagan, H., & Perlman, D. C.
Page(s)290-298AbstractBackground and aims: HIV has reached high prevalence in many non-injecting drug user (NIDU) populations. The aims of this study were to (1) examine the trend in HIV prevalence among non-injecting cocaine and heroin NIDUs in New York City, (2) identify factors potentially associated with the trend and (3) estimate HIV incidence among NIDUs. Design: Serial-cross sectional surveys of people entering drug treatment programs. People were permitted to participate only once per year, but could participate in multiple years. Setting: Mount Sinai Beth Israel drug treatment programs in New York City, USA. Participants: We recruited 3298 non-injecting cocaine and heroin users from 2005 to 2014. Participants were 78.7% male, 6.1% white, 25.7% Hispanic and 65.8% African American. Smoking crack cocaine was the most common non-injecting drug practice. Measures: Trend tests were used to examine HIV prevalence, demographics, drug use, sexual behavior and use of antiretroviral treatment (ART) by calendar year; χ2 and multivariable logistic regression were used to compare 2005–10 versus 2011–14. Findings: HIV prevalence declined approximately 1% per year (P < 0.001), with a decline from 16% in 2005–10 to 8% in 2011–14 (P < 0.001). The percentages of participants smoking crack and having multiple sexual partners declined and the percentage of HIV-positive people on ART increased. HIV incidence among repeat participants was 1.2 per 1000 person-years (95% confidence interval = 0.03/1000–7/1000). Conclusions: HIV prevalence has declined and a high percentage of HIV-positive non-injecting drug users (NIDUs) are receiving antiretroviral treatment, suggesting an end to the HIV epidemic among NIDUs in New York City. These results can be considered a proof of concept that it is possible to control non-injecting drug use related sexual transmission HIV epidemics.