Substance Use and Adherence to Antiretroviral Therapy: What Is Known and What Is Unknown
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Purpose of Review
People who use drugs face multiple challenges to achieve optimal HIV treatment outcomes. This review discusses the current knowledge in substance use and antiretroviral therapy adherence, highlighting recent findings and potential interventions.
Studies continue to demonstrate the negative impacts of substance use and related disorders on antiretroviral therapy adherence, with the exception of cannabis. Evidence-based addiction treatment, in particular, opioid agonist therapy, appears to improve adherence levels. Most individual-level adherence specific interventions did not provide sustained effects, and no studies evaluating structural-level interventions were found.
Findings suggest the urgent need to scale-up opioid agonist therapy, as well as to simultaneously address multiple structural barriers to care to optimize HIV treatment outcomes among people who use drugs.
KeywordsAdherence Antiretroviral therapy People who use drugs People who inject drugs Opioid agonist therapy Cannabis
MES is supported by Michael Smith Foundation for Health Research (MSFHR) and Canadian Institutes of Health Research (CIHR) fellowship awards. M-JM is supported in part by NIH (U01-DA021525), a Scholar Award from MSFHR and a New Investigator award from the Canadian Institutes of Health Research (CIHR).
Compliance with Ethical Standards
Conflict of Interest
M. Eugenia Socías and MJ Milloy declare that they have no conflict of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
M-JM’s institution has received an unstructured gift to support him from NG Biomed Ltd., a private firm seeking a government license to produce medical cannabis.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
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