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April 14, 2010

Enhanced HIV Testing, Treatment, and Support for HIV-Infected Substance Users

Author Affiliations

Author Affiliations: National Institute on Drug Abuse, National Institutes of Health, Bethesda, Maryland (Dr Volkow); British Columbia Centre for Excellence in HIV/AIDS, Providence Health Care, and University of British Columbia, Vancouver, British Columbia (Dr Montaner); and International AIDS Society, Geneva, Switzerland (Dr Montaner).

JAMA. 2010;303(14):1423-1424. doi:10.1001/jama.2010.421

Enhanced human immunodeficiency virus (HIV) testing and treatment have been proposed as a strategy to further decrease AIDS-related morbidity and mortality and to reduce HIV transmission.1 Appropriate use of highly active antiretroviral therapy (HAART) stops viral replication, rendering HIV-1 RNA levels undetectable in plasma and sexual fluids. As a result, continued use of HAART leads to long-term remission of HIV disease and decreased risk of HIV transmission. The latter has been most dramatically illustrated with vertical transmission: use of HAART has virtually eliminated vertical HIV transmission in the developed world. A protective effect of HAART has also been reported in HIV serodiscordant heterosexual couples and in longitudinal population-based studies. More recently, this association has also been substantiated in a longitudinal cohort involving intravenous drug users.2