AIDS Program, Yale University School of Medicine.
Clin Infect Dis. 2013 Nov;57(9):1309-17. doi: 10.1093/cid/cit427. Epub 2013 Jun 23.
Substance use disorders (SUDs) and human immunodeficiency virus (HIV) are pervasive epidemics that synergize, resulting in negative outcomes for HIV-infected people who use drugs (PWUDs). The expanding epidemiology of substance use demands a parallel evolution of the HIV specialist-beyond HIV to diagnosis and management of comorbid SUDs. The purpose of this paper is to describe healthcare disparities for HIV-infected PWUDs along each point of a continuum of care, and to suggest evidence-based strategies for overcoming these healthcare disparities. Despite extensive dedicated resources and availability of antiretroviral therapy (ART) in the United States, PWUDs continue to experience delayed HIV diagnosis, reduced entry into and retention in HIV care, delayed initiation of ART, and inferior HIV treatment outcomes. Overcoming these healthcare disparities requires integrated packages of clinical, pharmacological, behavioral, and social services, delivered in ways that are cost-effective and convenient and include, at a minimum, screening for and treatment of underlying SUDs.
物质使用障碍（SUD）和人类免疫缺陷病毒（HIV）是普遍存在的流行病，它们相互协同，导致感染 HIV 的吸毒者（PWUD）出现负面后果。物质使用的不断扩大的流行病学需要 HIV 专家的平行发展——超越 HIV，以诊断和管理共病 SUD。本文的目的是描述 HIV 感染的 PWUD 在护理连续体的每一点上的医疗保健差距，并提出克服这些医疗保健差距的循证策略。尽管在美国投入了大量专门资源并提供了抗逆转录病毒治疗（ART），但 PWUD 继续面临 HIV 诊断延迟、进入和维持 HIV 护理减少、ART 启动延迟以及 HIV 治疗结果不佳的问题。克服这些医疗保健差距需要综合的临床、药理学、行为和社会服务套餐，以具有成本效益和方便的方式提供，其中至少包括对潜在 SUD 的筛查和治疗。
