Data released today at the 8th Conference on Retroviruses and Opportunistic infections in Chicago from a retrospective study by researchers at St James’s Hospital, Dublin have documented the rising rate of new HIV diagnoses among injection drug users (IDUs) in Dublin.
There are an estimated 13,000 heroin addicts in Dublin. Over 5,000 patients are currently receiving methadone treatment.
New infections among IDUs have been declining since 1989, when 121 new cases were diagnosed (85 male, 36 female). An all-time low of 12 new diagnoses was reached in 1998.
Recent data have shown that 22% of those newly diagnosed in Ireland as a whole are IDU. Since 1998 there has been a significant increase in IDUs testing HIV-positive at the GUIDE clinic in Dublin.
Between 1998 and 1999 there was a five-fold increase in new diagnoses among IDUs (the total of new diagnoses being 55 cases). Between January 1999 and June 2000 there were 96 new diagnoses (46 male and 50 female). This represents a significant alteration in the male-female ratio as compared with the epidemic among IDUs in 1989.
Of those patients diagnosed between 1999 and 2000 the mean age was 25 years, with a startling 40% of new diagnoses having occured in those under 22 years of age. 92% of these patients are also hepatitis C-positive.
Similar increases in HIV incidence have been seen in other risk groups in the same time period and it is possible that recent health education regarding HIV transmission, safer sex and needle sharing has become de-prioritised.
Risk behaviour in all groups may be a result of increased awareness of the availability and effectiveness of antiretroviral therapies for HIV, according to the researchers, as well as complacency due to the availability of figures demonstrating reduced incidence of HIV infection in the early 1990s.
The authors outlined the possible role that the introduction of a methadone treatment protocol may have played in fuelling the epidemic. This protocol allowed the formal organisation of the relationship between the primary and secondary care delivery of methadone treatment.
The strict implementation of this protocol resulted in the sudden removal of illegal methadone from the streets, which may have temporarily led to increased heroin use among those who previously only used methadone.
The authors noted similar trends among IDUs in other regions throughout the world, even those with extensive programmes of methadone maintenance, and recognised the challenge to public health that this second epidemic of HIV among IDUs in Ireland represents.
Clarke S et al. A rapidly increasing incidence of HIV infection in injecting drug users (IDU) in Ireland. Abstract 217. 8th Conference on Retroviruses and Opportunistic infections, Chicago, 4-8 February 2001.