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Research Reports: HIV/AIDS

What Is HAART?

The availability of HAART since 1996 has had a dramatic effect on the face of HIV/AIDS. HAART is a customized combination of different classes of medications that a physician prescribes based on such factors as the patient’s viral load, CD4⁺ lymphocyte count, and clinical symptoms. CD4⁺ lymphocytes are white blood cells that HIV infects and kills, leading to a weakened immune system and AIDS. Though not a cure, HAART controls viral load, helping to delay the onset of symptoms and achieve prolonged survival in people diagnosed with HIV/AIDS.⁵

With HAART, the medical consequences associated with HIV/AIDS have changed. New diagnoses of HIV-associated infections and some neurological complications, such as HIV dementia, have decreased since its introduction..^5,6 However, other neurological problems, such as peripheral nerve damage, have increased with the use of this therapy. HAART is also reported to be associated with increased lipid levels (including cholesterol) in the blood, abnormal glucose metabolism, and other clinical complications such as heart disease.

Potential interactions between HAART and medications used to treat drug addiction may decrease the effectiveness of either or both treatments. For instance, when methadone, a treatment for heroin and other opioid addictions, is administered with certain antiretroviral medications that are components of HAART therapy, the concentration of methadone in the blood is significantly decreased,⁹ potentially compromising its effectiveness. Research is under way to determine if buprenorphine, a newer medication for the treatment of opioid addictions, has similar liabilities.

One of the challenges for patients treated with HAART is adhering to the medication routine needed for maximum benefit from this therapy. Adherence can be particularly problematic for drug abusers with chaotic lifestyles, which can interfere with their ability to follow prescribed regimens. In addition, because HAART reduces viral load, some patients mistakenly believe that they do not need to adhere to the treatment regimen or that reduced viral load means elimination of the risk of transmitting HIV.^10,11,12 This belief can, in turn, lead to complacency about risk behaviors and resumption of unsafe sex and injection practices.¹³ NIDA supported research has helped to improve HIV outcomes among IDUs and has advanced new discoveries and approaches for treating medical consequences resulting from living longer with the disease.

Hepatitis C

HCV infection, the leading cause of liver disease, is highly prevalent among IDUs and often co-occurs with HIV. In fact, between 85 and 90 percent of HIV-infected IDUs may also be infected with HCV.⁷ NIDA-funded studies have found that within 3 years of beginning injection drug use, a majority of IDUs contract HCV.

Approximately 4 million people in the United States are currently infected with HCV; of these, approximately 400,000 are co-infected with HIV, enhancing the risk of severe liver disease, especially among drug addicts.⁸ Chronic HCV and HIV co-infection results in an accelerated progression to end-stage liver disease and death when compared with individuals infected with HCV alone.

While the treatment of co-occurring HIV and HCV presents certain challenges, treatment during the acute phase of HCV infection (i.e., within 6 to 12 months of detection) has shown promise. Treatment thereafter significantly improves infected patients’ quality of life and should also be pursued.

This page was last updated March 2006.

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Research Reports

This series of reports simplifies the science of research findings for the educated lay public, legislators, educational groups, and practitioners. The series reports on research findings of national interest.

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