title: Reducing rates of preventable HIV/AIDS-associated mortality among people living with HIV who inject drugs.
abstract: 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.
  
  
  
  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.
  
  
  
  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.
authors.affiliation: aBritish Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, VancouverbFaculty of Health Sciences, Simon Fraser University, BurnabycDepartment of Medicine, University of British Columbia, St. Paul's Hospital, Vancouver, British Columbia, Canada.
authors.forename: Surita
authors.initials: S
authors.lastname: Parashar
authors.forename: Alexandra B
authors.initials: AB
authors.lastname: Collins
authors.forename: Julio S G
authors.initials: JS
authors.lastname: Montaner
authors.forename: Robert S
authors.initials: RS
authors.lastname: Hogg
authors.forename: Michael-John
authors.initials: MJ
authors.lastname: Milloy
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000188:drug therapy / Q000401:mortality*; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D006297:Health Services Accessibility; D006801:Humans; D055118:Medication Adherence; D058850:Opiate Substitution Treatment; D057545:Social Stigma; D015819:Substance Abuse, Intravenous / Q000150:complications* / Q000188:drug therapy
chemical_list: D044966:Anti-Retroviral Agents