The Natural History Of Human Immunodeficiency Virus ( Hiv )

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Since the introduction of novel antiretroviral therapy (ART) in the mid-1990s, the natural history of human immunodeficiency virus (HIV) disease has changed, such that persons infected with HIV have enjoyed substantial reductions in HIV/AIDS associated morbidity and mortality (1-4). A critical determinant of ART success however, depends on sustained adherence to the medication regimen. Previous studies have shown that ART adherence rates of ≥ 95% are associated with HIV viral suppression (5, 6), increased CD4+ cell count (7), and are also an important predictor of survival (8) and slower progression of disease (9).
It is important to note however, that the improved survival rates seen in HIV populations overall in the last two decades, have been less pronounced among HIV positive persons who use illicit drugs (10, 11). This discrepancy is partly attributable to poor ART adherence in this population (12). Nevertheless, persons who inject drugs with optimal adherence to ART can benefit from therapy to the same degree as other HIV-infected populations (13). However, ongoing substance use is consistently associated with low adherence to ART (14-16), which in turn results in worse virologic and immunologic outcomes among illicit drug users when compared to former drug users and non-users (17, 18). Encouragingly, illicit drug users who are engaged in substance abuse treatment, particularly methadone maintenance therapy (MMT), have improved access to ART (19, 20), achieved higher
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