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Substance use and HIV disease progression in the HAART era: implications for the primary prevention of HIV.

机译：HAART时代的物质使用与HIV疾病发展：对HIV一级预防的意义。

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摘要

Prior to the era of highly active anti-retroviral therapy (HAART), cohort studies provided equivocal evidence to support the hypothesis that substance use predicts more rapid HIV disease progression. The present review examined the effects of substance use on HIV disease progression in cohort studies with follow-up that continued into the HAART era. Of the 20 studies included in this review, 16 observed that substance use predicted at least one indicator of HIV disease progression. Ten of the 11 studies that followed participants exclusively in the HAART era observed an effect of substance use on HIV disease progression. Findings across studies indicate that stimulant use promotes more rapid HIV disease progression and the effects of substance use on HIV disease progression can persist after controlling for self-reported HAART non-adherence. Future investigations that examine the bio-behavioral pathways whereby substance use promotes HIV disease progression should include: measures of HIV genotypic and phenotypic resistance, multi-method assessment of adherence, and assessment of co-morbid infections that are more prevalent among substance users. Although further mechanistic research is needed, findings from existing cohort studies have clear clinical implications. Implementing screening, brief intervention and referral to substance abuse treatment in HIV medical care could optimize health outcomes and decrease HIV transmission rates by boosting the effectiveness of Test and Treat
机译：在高度活跃的抗逆转录病毒疗法（HAART）时代之前，队列研究提供了模棱两可的证据来支持以下假设：吸毒可预测HIV疾病的快速发展。本综述在队列研究中继续研究了药物使用对HIV疾病进展的影响，并一直持续到HAART时代。在本评价中包括的20项研究中，有16项观察到物质的使用至少预示了HIV疾病进展的一个指标。在仅参与HAART时代参与者的11项研究中，有10项观察到物质使用对HIV疾病进展的影响。多项研究发现，兴奋剂的使用可促进HIV疾病的快速发展，并且在控制自我报告的HAART不依从性后，药物使用对HIV疾病的影响仍将持续。未来检查药物滥用促进HIV病情发展的生物行为途径的未来调查应包括：HIV基因型和表型耐药性的测量，依从性的多方法评估以及对在物质使用者中更为普遍的共病感染的评估。尽管需要进一步的机理研究，但现有队列研究的发现具有明显的临床意义。在HIV医疗保健中实施筛查，短暂干预和将药物滥用治疗转诊可以通过提高测试和治疗的有效性来优化健康结果并降低HIV传播率

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