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Review
. 2016 Sep;11(5):507-513.
doi: 10.1097/COH.0000000000000297.

Reducing rates of preventable HIV/AIDS-associated mortality among people living with HIV who inject drugs

Surita Parashar  1 , Alexandra B Collins, Julio S G Montaner, Robert S Hogg, Michael-John Milloy
Affiliations
Review

Reducing rates of preventable HIV/AIDS-associated mortality among people living with HIV who inject drugs

Surita Parashar et al. Curr Opin HIV AIDS. 2016 Sep.

Abstract

Purpose of review: The modern antiretroviral therapy (ART) era has seen substantial reductions in mortality among people living with HIV. However, HIV-positive people who inject drugs (PWIDs) continue to experience high rates of suboptimal HIV-related outcomes. We review recent findings regarding factors contributing to premature and preventable mortality among HIV-positive PWID, and describe the promise of interventions to improve survival in this group.

Recent findings: The current leading causes of death among HIV-positive PWID are HIV/AIDS-related causes, overdose, and liver-related causes, including infection with hepatitis C virus. Elevated mortality levels in this population are driven by social-structural barriers to ART access and adherence, particularly criminalization and stigmatization of drug use. In contexts where opioid substitution therapy and ART adherence support programs are widely accessible, evidence highlights comparable levels of survival among HIV-positive PWID and people living with HIV who do not inject drugs.

Summary: The life-saving benefits of ART can be realized among HIV-positive PWID when it is paired with strategies that address barriers to evidence-based medical care. Joint administration of ART and opioid substitution therapy, as well as repeal of punitive laws that criminalize drug users, are urgently needed to reduce HIV and injection-related mortality among PWID.

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Figures

FIGURE 1
FIGURE 1
Sociostructural factors impacting survival of HIV-positive people who inject drugs.
See this image and copyright information in PMC

References

    1. Joint United Nations Programme on HIV/AIDS . The Gap Report. UNAIDS; Geneva: 2014. The report presents the sociostructural factors and policy obstacles that impede HIVpositive PWIDs from access to harm reduction, treatment, and prevention services worldwide.
    1. Van Santen DK, vander Helm JJ, Grady BP, et al. Temporal trends in mortality among people who use drugs compared with the general Dutch population differ by hepatitis C virus and HIV infection status. AIDS. 2014;28:2589–2599. - PubMed
    1. Hayashi K, Dong H, Marshall BD, et al. Sex-based differences in rates, causes, and predictors of death among injection drug users in Vancouver, Canada. Am J Epidemiol. 2016;183:544–552. Hayashi et al. demonstrated the impact of expanded public health interventions on reducing HIV-related mortality rates, highlighting the need for sex-specific interventions for female injection drug users in an urban Canadian setting. - PMC - PubMed
    1. Antiretroviral Therapy Cohort Collaboration Life expectancy of individuals on combination antiretroviral therapy in high-income countries: a collaborative analysis of 14 cohort studies. Lancet. 2008;372:293–299. - PMC - PubMed
    1. Lemahieu J-L, Me A. World Drug Report. UNODC; Vienna: 2014.

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