Evan Wood, MD, PhD; Julio S.G. Montaner, MD
Potential Conflicts of Interest: Dr. Wood: Grants/grants pending (money to institution): Canadian Institutes of Health Research, National Institutes of Health, MAC AIDS Fund, Open Society Foundation. Dr. Montaner: Grants/grants pending (money to institution): Gilead Sciences, Janssen, Merck, ViiV Healthcare, Agence Nationale de Recherches sur le SIDA et les Hépatites Virales, Bill & Melinda Gates Foundation, Office of the U.S. Global AIDS Coordinator/President's Emergency Plan for AIDS Relief, National Institutes of Health Office of AIDS Research, UNAIDS, International AIDS Society, Canadian Institutes of Health Research, National Institute on Drug Abuse.
Wood E, Montaner JS. Guidelines for Persons With HIV. Ann Intern Med. 2012;157:832-833. doi: 10.7326/0003-4819-157-11-201212040-00019
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Published: Ann Intern Med. 2012;157(11):832-833.
TO THE EDITOR:
Thompson and colleagues' review (1) of strategies to improve entry into and retention in HIV care and antiretroviral adherence for persons with HIV infection is timely, given the proven role of HIV testing and antiretroviral therapy in preventing the spread of HIV. Although we recognize that their review sought to identify strategies to improve entry into and retention in care and adherence, their article largely overlooked known barriers to HIV care, particularly with respect to challenges in delivering timely HIV care to persons with drug addiction.
Numerous studies have shown that frequent incarceration of persons with drug addiction promotes barriers to seeking HIV testing and treatment and contributes to the interruption of antiretroviral therapy once it has begun. Our group recently demonstrated a dose–response effect of incarceration episodes on HIV treatment nonadherence (2). A recent study of patients with HIV infection from Baltimore similarly found that periods of incarceration were associated with a 2-fold risk for syringe-sharing and a greater than 7-fold risk for virologic failure (3).
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