Infectious disease comorbidities adversely affecting substance users with HIV: hepatitis C and tuberculosis.
Infectious disease comorbidities adversely affecting substance users with HIV: hepatitis C and tuberculosis.
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DOI：
10.1097/qai.0b013e3181f9c0b6
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发表时间：
2010-12
期刊：
影响因子：
--
通讯作者：
Friedland G
中科院分区：
文献类型：
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作者：
Friedland G
吸毒，特别是注射吸毒，与艾滋病毒/艾滋病、丙型肝炎（HCV）和结核病（TB）之间的联系自艾滋病毒大流行开始以来就已得到承认。这些合并症影响到全世界的吸毒者，并协同作用，产生不良的生物学、流行病学和临床后果。结核病和丙型肝炎病毒的预防、护理和治疗可以取得成功，这两种疾病都可以治愈。然而，吸毒者面临的特殊临床挑战可能导致发病率和死亡率增加，并降低治疗成功率。其中包括有限的疾病筛查，不充分和不敏感的诊断，具有不同毒性的困难治疗方案，以及复杂的药代动力学和药效学药物相互作用。这可能导致诊断延迟、延迟开始治疗和完成率低，并可能产生和传播耐药生物。应对这些挑战的战略包括：在监狱和街头等非医疗环境中开展与药物滥用者接触的外展方案，开展艾滋病毒、丙型肝炎病毒和结核病的积极筛查方案，增加和扩大临床医生的专业知识，了解并避免药物相互作用，关注感染控制，使用异烟肼预防性治疗，以及确保药物依从性的创造性策略。所有这些都需要针对全面预防和治疗方案进行结构性改革，并加强对药物滥用者所需服务的合作和整合。
The linkage between drug use, particularly injection drug use, and HIV/AIDS, hepatitis C (HCV), and tuberculosis (TB) has been recognized since the beginning of the HIV pandemic. These co-morbid conditions affect drug users worldwide and act synergistically, with resultant adverse biologic, epidemiologic and clinical consequences. Prevention, care, and treatment of TB and HCV can be successful, and both diseases can be cured. Special clinical challenges among drug users, however, can result in increased morbidity, mortality and decreased therapeutic success. Among these are limited disease screening, inadequate and insensitive diagnostics, difficult treatment regimens with varying toxicities, and complicated pharmacokinetic and pharmacodynamic drug interactions. These may result in delayed diagnosis, deferred treatment initiation, and low completion rates, with the potential for generation and transmission of drug resistance organisms. Strategies to address these challenges include outreach programs to engage substance abusers in non-medical settings, such as prisons and the streets, active screening programs for HIV, HCV and TB, increased and broadened clinician expertise, knowledge and avoidance of drug interactions, attention to infection control, use of isoniazid preventive therapy, and creative strategies to insure medication adherence. All of these require structural changes directed at comprehensive prevention and treatment programs and increased collaboration and integration of needed services for substance abusers.