HIV Treatment as Prevention Among Injection Drug Users

HIV Treatment as Prevention among Injection

Drug Users

 Evan Wood, MD, PhD, ABIM, FRCPC

ABSTRACT

The use of highly active antiretroviral therapy (HAART) as a strategy to prevent the transmission of HIV infection is of substantial international interest. Injection drug users (IDU) are an important population with respect to HIV treatment as prevention since they are often less likely to access HAART in comparison to other risk groups. A recent multi-centre randomized clinical trial demonstrated a 96% reduction in HIV transmission among heterosexual sero-discordant couples prescribed early HAART.  Consistent with these results, independent observational studies from Baltimore and Vancouver have demonstrated that population level rates of HAART use among IDU are associated with reduced rates of HIV incidence.  In addition, impact assessments of HAART delivery to IDU have generally demonstrated no negative effects of HAART use on rates of unsafe sex or syringe sharing. HAART prevents HIV transmission because it dramatically decreases HIV-1 RNA levels in biological fluids. This is relevant to vertical and sexual HIV transmission and also to blood borne HIV transmission, as it is often the case among IDU. Efforts to expand HAART to injection drug users should be redoubled, including addressing structural barriers stemming from the ongoing criminalization of this population