ANTIVIRAL THERAPY BENEFITS HIV INFECTED STIMULANT USERS
New clinical research from UC San Francisco shows that 341 HIV-infected
men who reported using stimulants such as methamphetamine or cocaine derived
life-saving benefits from being on antiretroviral therapy that were comparable
to those of HIV-infected men who do not use stimulants.
That
said, those who reported using stimulants at more than half of at least two
study visits did have modestly increased chances of progressing to AIDS or
dying after starting antiretroviral therapy compared to non-users. The data was
collected between 1996 and 2012.
"Patients
with HIV who use stimulants and other substances often experience difficulties
with accessing antiretroviral therapy, partially due to the concerns of
healthcare providers that they will not be able take their medications as
directed. Findings from this study demonstrate that many stimulant users take
their antiretroviral therapy at levels sufficient to avoid negative clinical
outcomes. When we look at overall mortality, antiretroviral therapy leads to
similar clinical benefits for both stimulant users and non-users,
notwithstanding stimulant use," said the study's primary investigator,
Adam W. Carrico, PhD., UCSF assistant professor of nursing.
The
research is available starting in October online ahead of print in the Journal of Acquired Immune Deficiency
Syndromes. The study included 1,313
HIV-infected men who have sex with men within the Multicenter AIDS Cohort
Study, an ongoing nationwide prospective study of HIV infection among men who
have sex with men in the U.S.
"If
we are to achieve the goals of the President's National HIV/AIDS Strategy and
UNAIDS to end the HIV/AIDS epidemic, we will need to treat HIV-positive active
substance users for their HIV while encouraging them to stop or reduce their
substance use. Programs integrating substance abuse services with HIV clinical
care may both improve health outcomes for patients and reduce new
infections," said Carrico.
The
UCSF Division of HIV/AIDS at San Francisco General Hospital has created an
integrated care delivery system that could serve as a model for other clinics,
added Carrico. The HIV primary care clinic utilizes a patient centered team
care approach that includes substance abuse services for stimulant and opioid
users, along with mental health services, all located onsite. STOP, the
"stimulant treatment outpatient program," within the clinic provides
outpatient substance abuse and mental health treatment integrated with
patients' primary medical care.
"The
pattern of use varies and the real issue is whether patients can take their
antiretrovirals as prescribed. We find that some patients are able to start
taking antiretrovirals very reliably before they are able to decrease or stop
their stimulant use, which often requires more complex behavioral, emotional, interpersonal
and environmental changes. Being in an HIV primary care setting allows us to
engage stimulant users even if they are not ready to go to specialty substance
abuse programs or support groups," said Valerie Gruber, PhD, STOP director
and UCSF professor of psychiatry.
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