How Can HIV Be Prevented and Treated in Drug-Using Populations?
Cumulative research has shown that drug addiction treatment, community-based outreach, testing, and linkage to care for HIV and other infections are the most effective ways to reduce HIV transmission among drug-abusing individuals. Combined pharmacological and behavioral treatments for drug abuse have a demonstrated impact on HIV risk behaviors and incidence of HIV infection.33 For example, recent research showed that when behavioral therapies were combined with methadone treatment, approximately one-half of study participants who reported injection drug use at the outset of the study reported no such use at the end of the study, and over 90 percent of all participants reported no needle sharing.34 Drug treatment programs also serve an important role in providing current information on HIV and related diseases, counseling and testing services, and referrals for medical and social services.
Opportunities to Improve HIV Prevention and Treatment:
- Make HIV testing a routine part of healthcare.
- Initiate HAART therapy early to decrease HIV viral load and reduce infectivity.
- Establish a continuum of care to improve linkage to substance abuse and HIV treatment within the criminal justice system and upon prisoner reentry.
- Improve rates of testing and treatment among African- Americans, MSM, and other groups disproportionately impacted by the epidemic.
NIDA is also investing in research to identify the most effective strategies to treat HIV among drug users. The mistaken belief that IDUs are unlikely to benefit from HAART because of their chaotic lifestyles has resulted in delays in delivering HIV treatments to drug abusing populations, or even withholding of those treatments — dramatically compromising the quality of life for these individuals and their partners (see figure). This further burdens the healthcare community, leaving unchecked illness within this population.35 These misperceptions have been refuted by a recent study showing no difference in survival between IDUs and non-IDUs receiving HAART.36
Moreover, treatment of drug addiction may actually improve adherence to HIV treatment. Studies show, for example, that treating opioid addiction with buprenorphine or methadone improves both adherence to HAART and the quality of care in HIV+ individuals with a history of opioid abuse.37,38 These studies confirm that drug addiction should not be a barrier to HIV treatment and that treatment of both conditions is both necessary and effective.
Text Alternative for Graph of HIV+ IDUs Are Less Likely to Receive HAART Treatment than Non-IDUs
NIDA-funded research is also investigating new technologies to make adherence easier, more accessible, and relevant to targeted audiences. For example, text-messaging and other smartphone applications are being tested to help HIV+ youth improve adherence to HAART treatment. Culturally sensitive and gender-specific Web sites are also under development, designed to provide information to vulnerable populations to help modify risky behaviors, prevent infection, and build social support networks.
Finally, since treatment of co-occurring drug addiction and HIV infection may involve the use of multiple medications, there can be a risk of drug interactions that can decrease the effectiveness of either or both treatments. For instance, when methadone is administered to treat heroin and other opioid addictions along with certain antiretroviral medications (ARVs) that are components of HAART therapy, the concentration of methadone in the blood is significantly decreased,39 potentially compromising its effectiveness. Newer medications are now available to address these issues. Specifically, buprenorphine — a medication approved for the treatment of opioid addiction in 2002 — does not display the same cross-reactivity with the majority of ARVs and is thus a better choice for HIV+ patients who require treatment for both. 40, 41
As a result of scientific research, we know that addiction is a disease that affects both brain and behavior.