CMEonHIV.com is dedicated to providing online CME presentations (slides with voiceover) on HIV/AIDS for healthcare professionals given by local and international experts to keep you up-to-date on the ongoing developments in the field.
Conference
"HIV Infection among Marginalized Groups: People who use Illegal Drugs in Vancouver" Dr. Mark Tyndall (biography) English - 2002-04-15 - 25 minutes
(22 slides)
Summary : The introduction of highly active antiretroviral therapy (HAART) has led to major reductions in morbidity and mortality, as well as an enhanced quality of life for many HIV-positive individuals. However, global disparities in access to potentially life-saving medications and HIV-directed health care remains a monumental public health challenge. In the Canadian context, access and adherence to antiretroviral therapy is also uneven and highly dependent on individual circumstances, co-morbidity's, and the concurrent use of illicit drugs. Injection drug users (IDUs), as a group, are less likely to access HAART and HIV care is inferior among IDUs when compared to men who had sex with men. Concerns regarding accelerated resistance in poorly adherent individuals may also delay the initiation and continuation of therapy.
Data collected in the Vancouver Injection Drug Users Study (VIDUS) has shown that approximately half of all HIV-positive participants have ever received therapy and only 24% were on HAART at their last follow-up visit. Female gender, heroin use, and unstable housing were associated with lower uptake of HAART, whereas those on methadone maintenance therapy were four-fold more likely to be receiving HAART. Furthermore, interruptions in HAART occurred in 59% of individuals who had initiated HAART and this was associated with younger age, recent incarceration, and binge patterns of drug use.
Physician education, simplified treatment regimes, programs to improve adherence through supervised distribution of drugs, and linking addiction treatment with HIV care are programs that may enhance uptake and sustainability of antiretroviral therapy. Access and utilization of prophylactic antimicrobials should also be included in these initiatives as evidenced by the large number of deaths due to PCP pneumonia.
HIV-related illness will greatly accelerate mortality rates among IDUs in the next few years. HIV prevention efforts should remain the focus of public health policy through safe injection practices, needle exchange programs, addiction treatments, enhanced social supports and the prevention of injection drug use. Optimizing access and adherence to antiretroviral medications through innovative programs can have a major impact on mortality.
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