Clinical Care of the HIV-Infected Drug User

Bruce, R. Douglas; Altice, Frederick L.

doi:10.1016/j.idc.2007.03.009

Cited by 71 publications

(57 citation statements)

References 117 publications

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“…[27][28][29] Research has shown that drug users are often less likely to be prescribed HAART. 30,31 Findings were reported in 2008 on a population-based cohort study of over 3000 antiretroviral-naive HIV-infected patients compared HAART outcomes among individuals with and without a history of injection drug use. 32 A total of 915 participants had histories of injection drug users and the median duration of follow-up was over 5 years.…”

Section: Highly Active Antiretroviral Therapy Among Hiv-infected Drugmentioning

confidence: 99%

Expanded Highly Active Antiretroviral Therapy Coverage Among HIV-Positive Drug Users to Improve Individual and Public Health Outcomes

Montaner

Wood

Kerr

et al. 2010

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Highly active antiretroviral therapy (HAART) represents the single most significant advance in the fight against HIV/AIDS. The vast majority of patients treated with HAART will experience long-term remission of HIV disease. HAART does not cure HIV of course, but it changes the disease into a chronic and manageable condition. Use of HAART is associated with decreased HIV/AIDS-related morbidity, fewer opportunistic infections, and reduced mortality. Evidence has also shown that HAART can reduce HIV transmission. This is most clearly illustrated in studies of vertical or mother-to-child HIV transmission, in which use of HAART by the infected mother has virtually eliminated HIV transmission to her infant. Research has further shown that HAART use among heterosexual discordant couples in Africa was associated with a 92% reduction in HIV transmission. Until recently, the use of HAART among drug-using populations has remained controversial. However, HAART has now been shown to produce similar survival benefit when individuals with and without history of drug use were compared. This article discusses the need for an expansion in the provision of HAART to those in medical need, including drug users, to curb the devastating toll of the HIV pandemic. Such an effort should be done with the full promotion of human rights, including the need to respect each patient's privacy and autonomy. Public health programs to intensify HAART use should be carried out within a comprehensive "combination prevention" framework. Such an approach for drug users would emphasize drug addiction treatment, HIV prevention including HIV testing and counseling and behavioral risk reduction interventions, and the removal of structural barriers to treat HIV-infected drug users and retain them in care.

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Section: Highly Active Antiretroviral Therapy Among Hiv-infected Drugmentioning

confidence: 99%

Expanded Highly Active Antiretroviral Therapy Coverage Among HIV-Positive Drug Users to Improve Individual and Public Health Outcomes

Montaner

Wood

Kerr

et al. 2010

JAIDS Journal of Acquired Immune Deficiency Syndromes

View full text Add to dashboard Cite

show abstract

“…Many conditions commonly observed in injection drug users, including viral hepatitis, mental illness, poverty, incarceration, homelessness, and a poor relationship with the existing traditional health care system, complicate treatment of HIV infection and efforts to prevent HIV transmission [30]. Because the epidemics of IDU, substance use disorder, and HIV infection are interrelated it is critical to consider treatments for one disease in the context of the others [31].…”

Section: Injection Drug Use and Hiv Infection: Interdependent Healthmentioning

confidence: 99%

Strategies for Primary HIV Prevention That Target Behavioral Change

Safren

Wingood

Altice

2007

Clinical Infectious Diseases

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In the absence of a vaccine or cure, behavioral change remains the major method to prevent transmission of the human immunodeficiency virus (HIV). Public awareness campaigns that disseminate information about the risks and routes of transmission, although important, have an insufficient influence on the behavioral changes essential to reduce the risk of HIV infection. Because of the complex interplay of cultural and psychosocial influences that guides human behavior, specific programs to decrease high-risk behavior have been developed for target populations. In this report, tested initiatives for preventing HIV infection are summarized and their success evaluated for men who have sex with men, injection drug users, and women of minority racial groups. Objective evidence of reductions in high-risk behavior in these 3 groups, which account for the majority of HIV transmissions in the United States, has critical implications for reducing the overall rate of new HIV infections.

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“…Their complex needs can lead to barriers to normal HIV care [7]. Integrating HIV care with methadone maintenance facilitates specialist multidisciplinary care [8] and directly observed therapy (DOT) of the antiretroviral treatment [9]. DOT of antiretroviral treatment improves adherence and immunologic status, is most effective for patients at risk of non-adherence [10] and has demonstrated effectiveness in methadone maintenance programmes [11][12][13].…”

Section: Introductionmentioning

confidence: 99%