Major Contributions

1988

• ALIVE clinic opens recruiting 2960 injection drug users in 13 months; 24% of those recruited are HIV seropositive and 90% of HIV positives return for results

1990-1992

• Studies are published on risk factors (such as needle sharing) for HIV seroconversion; infection risk is noted to be high among new onset IDUs
• AIDS knowledge test shows that IDUs are as or more informed about HIV as the general population
• Study shows that bleach disinfection of needles does not show significant reduction in HIV risk
• Study shows that drug users who use alcohol swipes before injection have half the risk of endocarditis or skin abcesses
• Early studies of co-infections done including prevalence and risk factors for hepatitis B and C, syphilis, HTLV II: none appear to be co-factors for HIV progression

1993

• ALIVE investigators evaluated emerging needle exchange programs and partnered with the Baltimore City Health department to develop the Needle Clean-Up Project

1994

• Using data from the ALIVE study, the Maryland State Legislature passes a bill signed by the Governor to permit needle exchange in Baltimore
• ALIVE study serves as basis for the HERS Study (CDC study of HIV in Women that continues for eight years)
• ALIVE study serves as basis for the REACH and DUIT studies (CDC and NIH studies of new onset injection drug users that continues for nine years)

1995

• ALIVE participants enrolled into AVEG 201, the first HIV vaccine trial to enroll injection drug users study shows high level of comprehension and return rates equal to other participants
• Limited access to care identified as a barrier to AZT initiation among IDUs
• Risk factors for hepatitis B, hepatitis C and HTLV infections among IDUs are identified and found to be similar to those for HIV infection

1996-1997

• Through partnership with NCI, the role of genetic markers (CCR5) on HIV infection and disease progression is identified; paper is cited over 1000 times
• Documentation of poor nutritional status among IDUs prompts submission of ancillary proposals to study nutrition among IDUs
• Reductions in high risk behavior are observed among ALIVE participants in the Needle Exchange Program
• ALIVE provides one of the first estimates of Hepatitis E virus prevalence in drug users

1998

• HIV viral load identified as an independent prognostic marker of HIV disease progression
• Audio Computer-Assisted Self-Interview (ACASI) implemented as a tool to more accurately capture self-reported risk behaviors
• Report shows that at same CD4 count, HIV viral loads are lower in women than men which triggers studies on mechanisms and possible treatment recommendation implications
• HIV viral evolution studies performed to distinguish rate of HIV progression
• ALIVE study to show that shortly after the introduction of HAART, most drug users eligible for treatment in first year it is available do not receive it

2001

• HAART utilization in ALIVE lags behind MACS (homosexual men) study
• Concerns that HAART might result in resumption of HIV risk behaviors is addressed in an analysis of ALIVE data; modest increase in sex (but not drug) risk is observed and the recommendation is to counsel and monitor patients on treatment

2004

• Study demostrates that survival in HAART recipients is approaching that of uninfected persons
• Even though HAART reduces mortality substantially, access remains suboptimal among IDUs

2006

• Trends of HIV incidence in IDUs in Baltimore show decrease since 1994

2008

• Despite changes in NIH guidelines and availability of treatment, there are low rates of HCV treatment uptake in Baltimore, MD; more effort is needed to get IDUs over the initial hurdle for overall treatment effectiveness

2009-2010

• Studies begin to focus on aging and non-AIDS outcomes among HIV-infected persons including liver, pulmonary, renal and neurologic diseases
• In an aging, predominantly African American cohort of injection drug users, proteinuria was strongly associated with HIV status

2012

• An intervention study focused on improving linkage to HIV care for ALIVE participants begins

2013

• Study finds that among people infected with the hepatitis C virus (HCV), co-infection with HIV speeds damage and scarring of liver tissue by almost a decade.
• Genetic investigation of people infected with HCV finds two genetic mutations that make it more likely that patients’ immune systems can rid the body of HCV.

• Expanded our prior analyses of latent classes of substance use to look for longitudinal changes over time. We are updating analyses to evaluate temporal trends in overdose since the COVID-19 pandemic and finally are updating trajectory analyses to incorporate both substance use and medication for opioid use disorder.
• Started utilizing a mobile van vital in following participants that face transportation challenges and other barriers in getting to the research clinic.
• Conducted a major revision of ALIVE core instruments.
• Continued to evolve our surveys to collect information on COVID-19 impacts among PWID.
• 2023-ALIVE clinic opens recruitment