-
Views
-
Cite
Cite
Timothy P. Flanigan, Jennifer A. Mitty, The Good, the Bad, and the Ugly: Providing Highly Active Antiretroviral Therapy When It Is Most Difficult, Clinical Infectious Diseases, Volume 42, Issue 11, 1 June 2006, Pages 1636–1638, https://doi.org/10.1086/503916
Close - Share Icon Share
Extract
A 32-year-old man walks into clinic after having missed several medical appointments over the previous 4 months. He is an active injection drug user (IDU) who usually injects both heroin and cocaine. In the past 2 months, he joined a methadone-maintenance program; he is injecting less frequently because he is using less heroin, but he continues to use cocaine. A CD4 cell count, which had been determined 9 months ago, was 110 cells/mm3, and he is concerned about his health.
As a provider of AIDS care, you wonder what the best approach is. Many clinicians would require the patient to be drug free before prescribing antiretroviral therapy. Others may require long periods of excellent adherence to medical visits before initiating HAART. The reason for these approaches is the concern that imperfect adherence to therapy will lead to the development of antiretroviral resistance, which could limit future treatment options, as well as result in transmission of drug-resistant virus. However, by limiting access to antiretroviral therapy, a patient such as the one we describe is at high risk of opportunistic infections and death [1]. Is that the best approach? What are your options? The 2 articles in this issue of Clinical Infectious Diseases by Lucas et al. [2] and Wohl et al. [3] provide important insight into adherence interventions among both substance users and persons attending inner city public health HIV clinics.
