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What’s new for injection drug users with HIV infection?
  1. S M Clarke1,
  2. F M Mulcahy2
  1. 1Department of Infectious Diseases, Boston Medical Center, 1 Boston Medical Center Place, Dowling 3N, Room 3211, Boston, MA 02118, USA
  2. 2GUIDE Clinic, St James’s Hospital, James’s Street, Dublin 8, Ireland
  1. Correspondence to:
 Susan Clarke;

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Difficulties of providing long term medications to this unique group of patients

Injection drug use represents the risk factor for human immunodeficiency virus (HIV) infection for the minority of worldwide HIV disease.1 In contrast, injection drug use in developed countries accounts for between 30% and 60% of the HIV infected population.1 Much of the published HIV literature focuses on large randomised clinical trials of highly active antiretroviral therapy (HAART) regimens, potential adverse reactions from HAART, and the basic science of HIV infection. There is generally a paucity of research focusing exclusively on injecting drug users (IDUs). A literature review was undertaken to review published data from 1999 to 2001, focusing on articles that directly relate to IDUs and HIV infection. Most of the derived data relate to the following areas:

  1. Increasing epidemics of HIV infection in IDUs in developing countries

  2. Improving access to care for IDUs

  3. Co-infection with hepatitis C virus

  4. Pharmacokinetic interactions between antiretrovirals and methadone.


Until recently, the concept of IDU was essentially a Western world phenomenon, concentrated in regions of the United States and Western Europe where HIV infection is mainly subtype B disease. In developing countries and countries in political transition where HIV infection was previously vastly under-reported, and IDU was not a significant problem, it is only now that real epidemics of HIV infection among IDUs are occurring and being accurately reported.1 Molecular methods and phylogenetic analysis are helping to trace and follow the epidemics.

In many parts of Asia, the HIV epidemic has spread extensively since the 1980s, with multiple, genetically divergent subtypes, but with a predominance of subtype A.2 In China, a similar epidemic has been reported with subtype C predominating. Lai et al describe data from Guang Xi province in China, where there has been a threefold increase …

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