Article

Illicit drugs, alcohol, and addiction in human immunodeficiency virus

Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center, Boston University School of Medicine, Boston, MA 02118, USA.
Panminerva medica (Impact Factor: 2.28). 07/2007; 49(2):67-77.
Source: PubMed

ABSTRACT Drug and alcohol use complicate both the prevention and treatment of human immunodeficiency virus (HIV) infection. Substance use is one of the major engines driving HIV transmission, directly, through the sharing of injection drug use equipment and indirectly, through increasing risky sexual behaviors. Drug and alcohol dependence compromise effective HIV treatment by influencing both access and adherence to antiretroviral therapy. Exposure to addictive substances may have direct immunosuppressive effects independent of their impact on access and adherence to treatment. Measures effective at minimizing HIV transmission attributable to drug and alcohol use include HIV testing and referral to treatment, syringe and needle exchange programs, opioid replacement therapy (i.e., methadone and buprenorphine), and behavioral interventions targeting HIV risk behaviors among both HIV-infected and HIV-uninfected people. Measures effective at optimizing HIV treatment among alcohol and drug-dependent patients include HIV testing with referral to treatment and substance use treatment that is linked to or integrated into HIV treatment. Due to the intertwining problems of substance use and HIV infection, physicians and other health care providers must address the issues of illicit drugs and alcohol use as mainstream medical problems in order to provide optimal care for HIV-infected patients.

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    • "Establishing a successful patient-provider relationship may be linked with better outcomes for those living with HIV including lower viral loads, fewer comorbid illnesses, and slower progression to AIDS. Both alcohol and illicit drug use are common among HIV-infected patients [2] and may contribute to poorer adherence to antiretroviral therapy and less engagement with health care providers. Substance use, notably alcohol use, was found to predict HIV risk behavior and sensation seeking in a sample of men and women in South Africa [3] and contributes to lower utilization of and adherence to antiretroviral therapy [4]. "
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    AIDS research and treatment 04/2014; 2014:675739. DOI:10.1155/2014/675739
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    • "Heavy drinking is associated with poor antiretroviral (ART) adherence [3-5], is a leading cause of morbidity and mortality [6-10] among those with liver disease, and is a clinical challenge for those with HIV [11,12]. Despite calls to address this [8,13-16], heavy drinking remains prevalent in HIV clinic settings [13,15], where resources for interventions are often limited [17-19]. Recommendations to refer patients to outside treatment [11,20] do not solve this, since patients seldom follow referrals [21,22]. "
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    Addiction science & clinical practice 02/2014; 9(1):5. DOI:10.1186/1940-0640-9-5
    • "Substance abusers are prone to have high risk sexual behaviors, as there is a higher rate of non-inhibition, impaired judgment and impulsivity.[149] For these same reasons, they tend to be less compliant with anti-retroviral regimens.[50] Furthermore, alcohol use can accelerate HIV disease progression.[51] "
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