Adeeba Kamarulzaman1, Frederick L Altice. 1. aCentre of Excellence for Research in AIDS (CERiA), University of Malaya, Faculty of Medicine, Kuala Lumpur, Malaysia bYale University, School of Medicine, Section of Infectious Diseases cYale University, School of Public Health, Section of Epidemiology of Microbial Diseases, New Haven, Connecticut, USA.
Abstract
PURPOSE OF REVIEW: HIV management in people who use drugs (PWUD) is typically complex and challenging due to the presence of multiple medical and psychiatric comorbidities as well as social, physical, economic and legal factors that often disrupt the HIV continuum of care. In this review, we describe the individual, health systems and societal barriers to HIV treatment access and care retention for PWUD. In addition, the clinical management of HIV-infected PWUD is often complicated by the presence of multiple infectious and noninfectious comorbidities. RECENT FINDINGS: Improved HIV treatment outcomes can be enhanced through improved testing and linkage strategies along with better treatment retention and antiretroviral (ART) adherence. Improved ART adherence can be achieved through the provision of opioid substitution therapy (OST), directly administered ART (DAART) and integration of ART with OST services. Recent advances with direct-acting antivirals (DAAs) for hepatitis C virus (HCV) have shown superior outcomes than interferon-based regimes in HIV-HCV coinfected patients. Newer diagnostic technologies for tuberculosis (TB) hold promise for earlier diagnosis for PWUD coinfected with TB, and TB treatment outcomes are improved through combination with OST. SUMMARY: HIV-infected PWUDs are a key population who frequently experience suboptimal outcomes along the HIV continuum of care. A comprehensive strategy that encompasses evidence-based prevention and treatment interventions that target the individual, family, healthcare system, legal and societal structure is required to ensure greater participation and success in HIV treatment and care.
PURPOSE OF REVIEW: HIV management in people who use drugs (PWUD) is typically complex and challenging due to the presence of multiple medical and psychiatric comorbidities as well as social, physical, economic and legal factors that often disrupt the HIV continuum of care. In this review, we describe the individual, health systems and societal barriers to HIV treatment access and care retention for PWUD. In addition, the clinical management of HIV-infected PWUD is often complicated by the presence of multiple infectious and noninfectious comorbidities. RECENT FINDINGS: Improved HIV treatment outcomes can be enhanced through improved testing and linkage strategies along with better treatment retention and antiretroviral (ART) adherence. Improved ART adherence can be achieved through the provision of opioid substitution therapy (OST), directly administered ART (DAART) and integration of ART with OST services. Recent advances with direct-acting antivirals (DAAs) for hepatitis C virus (HCV) have shown superior outcomes than interferon-based regimes in HIV-HCV coinfectedpatients. Newer diagnostic technologies for tuberculosis (TB) hold promise for earlier diagnosis for PWUD coinfected with TB, and TB treatment outcomes are improved through combination with OST. SUMMARY:HIV-infected PWUDs are a key population who frequently experience suboptimal outcomes along the HIV continuum of care. A comprehensive strategy that encompasses evidence-based prevention and treatment interventions that target the individual, family, healthcare system, legal and societal structure is required to ensure greater participation and success in HIV treatment and care.
Authors: Jaimie P Meyer; Javier Cepeda; Johnny Wu; Robert L Trestman; Frederick L Altice; Sandra A Springer Journal: JAMA Intern Med Date: 2014-05 Impact factor: 21.873
Authors: Sasha Uhlmann; M-J Milloy; Thomas Kerr; Ruth Zhang; Silvia Guillemi; David Marsh; Robert S Hogg; Julio S G Montaner; Evan Wood Journal: Addiction Date: 2010-03-10 Impact factor: 6.526
Authors: Jessica E Hart; Christie Y Jeon; Louise C Ivers; Heidi L Behforouz; Adolfo Caldas; Peter C Drobac; Sonya S Shin Journal: J Acquir Immune Defic Syndr Date: 2010-06 Impact factor: 3.731
Authors: Michael-John S Milloy; Brandon D L Marshall; Thomas Kerr; Jane Buxton; Tim Rhodes; Julio Montaner; Evan Wood Journal: AIDS Date: 2012-06-01 Impact factor: 4.177
Authors: Farzana Kapadia; David Vlahov; Yingfeng Wu; Mardge H Cohen; Ruth M Greenblatt; Andrea A Howard; Judith A Cook; Lakshmi Goparaju; Elizabeth Golub; Jean Richardson; Tracey E Wilson Journal: Am J Drug Alcohol Abuse Date: 2008 Impact factor: 3.829
Authors: Panagiotis Vagenas; Shan-Estelle Brown; Jesse L Clark; Kelika A Konda; Javier R Lama; Jorge Sánchez; Ann C Duerr; Frederick L Altice Journal: Subst Use Misuse Date: 2017-02-07 Impact factor: 2.164
Authors: Kiyomi Tsuyuki; Eileen V Pitpitan; Maria A Levi-Minzi; Lianne A Urada; Steven P Kurtz; Jamila K Stockman; Hilary L Surratt Journal: AIDS Behav Date: 2017-08
Authors: Lyuba Azbel; Maxim Polonsky; Martin Wegman; Natalya Shumskaya; Ainura Kurmanalieva; Akylbek Asanov; Jeffrey A Wickersham; Sergii Dvoriak; Frederick L Altice Journal: Int J Drug Policy Date: 2016-06-11