Highly active antiretroviral therapy (HAART) equally effective in patients with or without history of injection drug use

Highly active antiretroviral therapy (HAART) has been extremely effective at slowing the progression of HIV infection to AIDS as well as extending the lives and improving the quality of life for those with HIV. However, some doctors have been reluctant to prescribe HAART to HIV-infected injection drug users because of concern that they may not fully benefit from the therapy.

A new study by investigators funded by the National Institute on Drug Abuse (NIDA), part of the National Institutes of Health, and led by the British Columbia Centre for Excellence in HIV/AIDS in Canada, suggests that this is not the case: in their large, community-based study of HIV-infected people, injection drug users and people who did not inject drugs had equivalent survival rates seven years after initiating HAART. These results will be published August 6 in the Journal of the American Medical Association.

"An estimated one million persons in the United States are living with HIV/AIDS, with approximately one-fourth of these cases attributable to injection drug use," said NIDA Director Dr. Nora D. Volkow. "This paper provides important evidence for the value of routinely providing HAART therapy to HIV-infected injection drug users who need treatment - benefiting both the patients and the public at large."

The study included 3,116 patients aged 18 years or older beginning HAART treatment for HIV, 915 of whom were injection drug users. To compare the number of deaths between the two groups, the researchers took into account that accidental deaths are more common for injection drug users and excluded those deaths from their analyses. When accidental deaths were excluded, the mortality rate seven years after beginning HAART therapy was equivalent for injection drug users (about 22 percent) and people who did not inject drugs (about 19 percent). The authors plan to continue to follow the study participants to gather data on longer-term survival.

"Hopefully, the findings from this study help address the commonly held assumption that HIV-positive injection drug users do not derive the full benefits of HIV treatment," says Dr. Evan Wood, lead author of the study. "We have an ethical and human rights imperative to deliver HIV care to this population, not only to reduce illness and death, but also to possibly reduce the rate of new infections in the community."

HAART consists of a 'cocktail' of at least three medications that can decrease HIV viral load. HAART cannot cure a person of HIV infection, which without treatment will almost always progress to AIDS.

HIV can be transmitted by contact with the blood or other body fluids of an infected person. Among people who inject drugs, HIV transmission can occur through sharing needles and other injection paraphernalia such as cotton swabs and rinse water.