Expanded highly active antiretroviral therapy coverage among HIV-positive drug users to improve individual and public health outcomes

Abstract

Highly active antiretroviral therapy (HAART) represents the single most significant advance in the fight against HIV/AIDS. The vast majority of patients treated with HAART will experience long-term remission of HIV disease. HAART does not cure HIV of course, but it changes the disease into a chronic and manageable condition. Use of HAART is associated with decreased HIV/AIDS-related morbidity, fewer opportunistic infections, and reduced mortality. Evidence has also shown that HAART can reduce HIV transmission. This is most clearly illustrated in studies of vertical or mother-to-child HIV transmission, in which use of HAART by the infected mother has virtually eliminated HIV transmission to her infant. Research has further shown that HAART use among heterosexual discordant couples in Africa was associated with a 92% reduction in HIV transmission. Until recently, the use of HAART among drug-using populations has remained controversial. However, HAART has now been shown to produce similar survival benefit when individuals with and without history of drug use were compared. This article discusses the need for an expansion in the provision of HAART to those in medical need, including drug users, to curb the devastating toll of the HIV pandemic. Such an effort should be done with the full promotion of human rights, including the need to respect each patient's privacy and autonomy. Public health programs to intensify HAART use should be carried out within a comprehensive "combination prevention" framework. Such an approach for drug users would emphasize drug addiction treatment, HIV prevention including HIV testing and counseling and behavioral risk reduction interventions, and the removal of structural barriers to treat HIV-infected drug users and retain them in care.