Diagnosis and treatment of substance use disorders in patients with HIV infection

Abstract

Drug users infected with the human immunodeficiency virus (HIV) are a rapidly growing group of patients whose optimal medical and psychiatric care requires that the substance use disorders are assessed and treated. Drug users have high rates of other psychiatric disorders even in the absence of HIV infection. The effects of acute and chronic drug use complicate the assessment of psychiatric symptoms. There is evidence that in the early stages of HIV disease, drug use plays a larger role in producing psychiatric disorders than does HIV itself. In general, neuropsychiatric problems do not appear to progress more rapidly in drug users than in HIV infected homosexual men. However, compliance with and adherence to medical care are major problems in the treatment of drug users. The combined treatment of substance use and psychiatric disorders may improve the likelihood that patients will receive adequate medical treatment of HIV disease, particularly if integrated systems of care are in place.