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Johns Hopkins Bloomberg School of Public Health

AIDS Linked to the Intravenous Experience Study

Major Contributions

The ALIVE study has contributed greatly to the study of injection drug users both with HIV and who are at risk of acquiring HIV. This timeline details the research accomplishments; click over to the study milestones to learn about the timeframe for study funding and recruitment.

To learn more about selected recent contributions, click through the links to the left.


• 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


• 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


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


• 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)


• 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


• 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


• 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


• 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


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


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


• 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


• 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


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


• 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.