Treatment of medical, psychiatric, and substance-use comorbidities in people infected with HIV who use drugs.
Treatment of medical, psychiatric, and substance-use comorbidities in people infected with HIV who use drugs.
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DOI：
10.1016/s0140-6736(10)60829-x
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发表时间：
2010-07-31
期刊：
影响因子：
--
通讯作者：
Friedland GH
中科院分区：
文献类型：
--
作者：
Altice FL;Kamarulzaman A;Soriano VV;Schechter M;Friedland GH
与不吸毒的艾滋病毒感染者相比，感染艾滋病毒的吸毒者的年龄对应发病率和死亡率有所增加。药物使用障碍对感染艾滋病毒的吸毒者的健康产生负面影响，他们还经常患有使艾滋病毒治疗和预防复杂化的医学和精神病合并症。有循证治疗可用于管理药物使用障碍、精神疾病、艾滋病毒和其他感染性并发症，如病毒性肝炎和肺结核，以及许多与艾滋病毒无关的合并症。感染艾滋病毒的吸毒者合并感染结核病，包括耐药菌株引起的疾病，是由于抗逆转录病毒治疗处方不足、坚持治疗不佳以及反复接触监狱等聚集环境而获得和传播的。药物辅助疗法为艾滋病毒治疗和预防工作提供了最有力的证据，但在最需要的地方往往得不到。抗逆转录病毒治疗，当处方和坚持是在一个最佳的，改善健康相关的结果，艾滋病毒感染及其许多合并症，包括结核病，病毒性肝炎，肾脏和心血管疾病。在HIV感染的吸毒者中同时临床管理多种合并症可能导致复杂的药代动力学药物相互作用，必须充分解决。此外，还需要采取干预措施，包括整合保健服务的提供，以提高坚持治疗的程度。迫切需要采取多方面、跨学科的方法，以实现艾滋病毒感染吸毒者健康结果的平等。
HIV-infected drug users have increased age-matched morbidity and mortality compared with HIV-infected people who do not use drugs. Substance-use disorders negatively affect the health of HIV-infected drug users, who also have frequent medical and psychiatric comorbidities that complicate HIV treatment and prevention. Evidence-based treatments are available for the management of substance-use disorders, mental illness, HIV and other infectious complications such as viral hepatitis and tuberculosis, and many non-HIV-associated comorbidities. Tuberculosis co-infection in HIV-infected drug users, including disease caused by drug-resistant strains, is acquired and transmitted as a consequence of inadequate prescription of antiretroviral therapy, poor adherence, and repeated interfaces with congregate settings such as prisons. Medication-assisted therapies provide the strongest evidence for HIV treatment and prevention efforts, yet are often not available where they are needed most. Antiretroviral therapy, when prescribed and adherence is at an optimum, improves health-related outcomes for HIV infection and many of its comorbidities, including tuberculosis, viral hepatitis, and renal and cardiovascular disease. Simultaneous clinical management of multiple comorbidities in HIV-infected drug users might result in complex pharmacokinetic drug interactions that must be adequately addressed. Moreover, interventions to improve adherence to treatment, including integration of health services delivery, are needed. Multifaceted, interdisciplinary approaches are urgently needed to achieve parity in health outcomes in HIV-infected drug users.