title: Challenges in managing HIV in people who use drugs.
abstract: OBJECTIVE
  HIV management in people who use drugs (PWUD) is typically complex and challenging due to the presence of multiple medical and psychiatric comorbidities as well as social, physical, economic and legal factors that often disrupt the HIV continuum of care. In this review, we describe the individual, health systems and societal barriers to HIV treatment access and care retention for PWUD. In addition, the clinical management of HIV-infected PWUD is often complicated by the presence of multiple infectious and noninfectious comorbidities.
  
  
  RESULTS
  Improved HIV treatment outcomes can be enhanced through improved testing and linkage strategies along with better treatment retention and antiretroviral (ART) adherence. Improved ART adherence can be achieved through the provision of opioid substitution therapy (OST), directly administered ART (DAART) and integration of ART with OST services. Recent advances with direct-acting antivirals (DAAs) for hepatitis C virus (HCV) have shown superior outcomes than interferon-based regimes in HIV-HCV coinfected patients. Newer diagnostic technologies for tuberculosis (TB) hold promise for earlier diagnosis for PWUD coinfected with TB, and TB treatment outcomes are improved through combination with OST.
  
  
  CONCLUSIONS
  HIV-infected PWUDs are a key population who frequently experience suboptimal outcomes along the HIV continuum of care. A comprehensive strategy that encompasses evidence-based prevention and treatment interventions that target the individual, family, healthcare system, legal and societal structure is required to ensure greater participation and success in HIV treatment and care.
authors.affiliation: aCentre of Excellence for Research in AIDS (CERiA), University of Malaya, Faculty of Medicine, Kuala Lumpur, Malaysia bYale University, School of Medicine, Section of Infectious Diseases cYale University, School of Public Health, Section of Epidemiology of Microbial Diseases, New Haven, Connecticut, USA.
authors.forename: Adeeba
authors.initials: A
authors.lastname: Kamarulzaman
authors.forename: Frederick L
authors.initials: FL
authors.lastname: Altice
mesh_terms: D019380:Anti-HIV Agents / Q000008:administration & dosage*; D060085:Coinfection; D015897:Comorbidity; D003266:Continuity of Patient Care; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000523:psychology; D006297:Health Services Accessibility / Q000458:organization & administration; D006526:Hepatitis C / Q000188:drug therapy* / Q000453:epidemiology; D006801:Humans; D055118:Medication Adherence / Q000523:psychology*; D001523:Mental Disorders / Q000150:complications / Q000188:drug therapy* / Q000453:epidemiology; D018671:Needle-Exchange Programs; D058850:Opiate Substitution Treatment / Q000379:methods; D012923:Social Class; D015819:Substance Abuse, Intravenous / Q000150:complications* / Q000453:epidemiology / Q000523:psychology; D019966:Substance-Related Disorders / Q000453:epidemiology; D014376:Tuberculosis / Q000188:drug therapy* / Q000453:epidemiology
chemical_list: D019380:Anti-HIV Agents