Substance use and HIV disease progression in the HAART era: Implications for the primary prevention of HIV

Research output: Contribution to journalReview article

66 Scopus citations

Abstract

Prior to the era of highly active anti-retroviral therapy (HAART), cohort studies provided equivocal evidence to support the hypothesis that substance use predicts more rapid HIV disease progression. The present review examined the effects of substance use on HIV disease progression in cohort studies with follow-up that continued into the HAART era. Of the 20 studies included in this review, 16 observed that substance use predicted at least one indicator of HIV disease progression. Ten of the 11 studies that followed participants exclusively in the HAART era observed an effect of substance use on HIV disease progression. Findings across studies indicate that stimulant use promotes more rapid HIV disease progression and the effects of substance use on HIV disease progression can persist after controlling for self-reported HAART non-adherence. Future investigations that examine the bio-behavioral pathways whereby substance use promotes HIV disease progression should include: measures of HIV genotypic and phenotypic resistance, multi-method assessment of adherence, and assessment of co-morbid infections that are more prevalent among substance users. Although further mechanistic research is needed, findings from existing cohort studies have clear clinical implications. Implementing screening, brief intervention and referral to substance abuse treatment in HIV medical care could optimize health outcomes and decrease HIV transmission rates by boosting the effectiveness of "Test and Treat" approaches to HIV prevention.

Original languageEnglish (US)
Pages (from-to)940-947
Number of pages8
JournalLife Sciences
Volume88
Issue number21-22
DOIs
StatePublished - May 23 2011
Externally publishedYes

Keywords

  • Adherence
  • Antiretroviral
  • Cocaine
  • Disease progression
  • HIV/AIDS
  • Highly active
  • Injection drug use
  • Methamphetamine
  • Mortality
  • Norepinephrine
  • Substance use
  • Survival

ASJC Scopus subject areas

  • Biochemistry, Genetics and Molecular Biology(all)
  • Pharmacology, Toxicology and Pharmaceutics(all)

Fingerprint Dive into the research topics of 'Substance use and HIV disease progression in the HAART era: Implications for the primary prevention of HIV'. Together they form a unique fingerprint.

  • Cite this