HIV infection among substance abusers in Thanyarak Institute On Drug Abuse, Thailand, 1987-2002.

A study of HIV infection among substance abusers from 1987 to 2002 was performed in Thanyarak Institute on Drug Abuse (TIDA). From 118,676 anti HIV tests (6,076 - 10,626 tests each year) of TIDA inpatients, 17,526 tests were positive (474 - 2,041 tests each year) In 71,403 new substance abuse cases (3,724 - 6,184 cases each year), 12,401 cases were positive (17.4%), highest in 1990 28.3% and then decreased to 8% in the last three years. In injecting drug users (IDU), the mean anti HIV positivity rate was 21.7% (range 19.2 - 29.4%) higher than those among non IDU about 8 times 2.8% (range 1.9 - 3.6%). The HIV incidence rates were from inpatients that were previously anti-HIV negative, the authors found the mean incidence rate was 7.3% per year. Anti HIV positive cases were highest in injecting heroin users (IHU) about 36.8% (range 31.5 - 46.1%). Although numbers of IHU in Thailand have decreased in the last 6 years because of changing to use methamphetamine by smoking and dying from HIV subtype B'. The authors must continue the effective preventive programs of both avoid sharing injecting equipments and promoting 100% condom program to control this reservoir of HIV infection.

The results of drug dependence treatment by therapeutic community in Thanyarak Institute on Drug Abuse.

A study of drug dependence treatment by therapeutic community (TC) in Thanyarak Institute on Drug Abuse from 1986 to 2000 was undertaken. 2,881 cases joined the TC program during this period (males 2,471 or 85.8%, females 410 or 14.2%). There were 278 cases who completed the TC program (males 261 or 93.9%, females 17 or 6.1%). The program course is at least one and a half year. The average duration of treatment in TC for the completion group was 27.6 +/- 7.1 months. The mean age was 30.9 +/- 6.4 years. About half of them had had a high school education. The majority (84.6%) of them were i.v. heroin addicts. The average drug-use duration was 9.8 +/- 5.7 years. After they completed the program, the clients were followed-up for five years. 203 cases (73.0%) were abstinent from drugs. Of this figure 21 cases (7.6%) had died during the follow-up from illness and accidents not directly related to relapsing to drugs. 75 cases (27.0%) relapsed to drugs. There were no significant differences between the abstinent and relapse cases in age, education, marital status, characteristic of addiction, previous treatment data and I.Q. Duration of treatment in the abstinent cases was longer (3.7 months) than the relapse cases. Significant differences (p < 0.05) were found in some personality characteristics. The relapse cases were neurotic-introversion personality type and had abnormal scores with low or high scores in hypersensitive character. They were likely to be easily stimulated to go back to using drugs. Although the TC program required much time and material resources to operate, the results of treatment were highly effective. The results of this study provide the rational to expand this TC program in order to provide more opportunities to the increasing demands for an effective treatment intervention for Thai addicts.

Prevalence and genotypes of hepatitis C virus infection among drug addicts and blood donors in Thailand.

Hepatitis C virus (HCV) is an infectious agent that has the potential to cause chronic liver disease, cirrhosis and hepatocellular carcinoma. We determined the prevalence and genotypes of HCV infection among groups of drug addicts: intravenous drug users (n = 134), methamphetamine users (n = 100), inhaled-drugs users (n = 19) and alcoholics (n = 50); a group of blood donors acted as a control. The control group consisted of 179 randomly-selected anti-HCV positive samples: these were subjected to HCV RNA screening and genotyping. The anti-HCV test was performed by ELISA: HCV RNA screening was by nested RT-PCR that employed primers from the 5' noncoding region. The genotype assay was based upon analysis of the 5' NCR amplified sequences and RFLP. Hepatitis C virus was highly prevalent among all groups of drug addicts (12-70%). In 2000. among the new blood donors (n = 66,340) at the National Blood Center, Thai Red Cross, anti-HCV prevalence amounted to 0.98%. The HCV genotype distribution showed that the most prevalent genotype was 3a, followed by 1b and 6a. Our data demonstrated the very high prevalence of HCV infection in IVDUs, a finding that is consistent with the blood-borne nature of the virus. In order to curb HCV infection, a determined effort to educate both the general population and high-risk groups is required; such a program of education would address both general and particular methods of transmission, especially the use of non-sterile needles etc.