HIV and Substance Use Disorders-Recording - HIV and Substance Use Disorders

Video Transcription

Video Summary

Dr. [Speaker], a family doctor boarded in addiction medicine and HIV specialization, discusses the intersection of HIV and substance use disorders, focusing on epidemiology, testing, treatment, and specific challenges in patients who use substances. In the U.S., about 1.2 million people live with HIV, with 13% unaware of their status. Substance use, especially stimulants like methamphetamine and cocaine, as well as alcohol and poppers, increases HIV transmission risk by disinhibiting behaviors. Patients using intravenous drugs require regular HIV screening, ideally every three months alongside STI testing. Acute HIV often presents with flu-like symptoms two to four weeks post-infection. Current guidelines recommend immediate antiretroviral therapy (ART), often same-day initiation with integrase inhibitor-based regimens due to their high resistance barrier and fewer drug interactions. Protease inhibitors and boosters interact with substances like methadone, GHB, and MDMA, necessitating tailored care. Chemsex—sex while using substances—is prevalent in men who have sex with men and is linked to higher-risk behaviors and STIs, complicating adherence to treatment. Harm reduction strategies include open, non-stigmatizing communication, providing clean supplies, naloxone for overdose prevention, frequent testing, and flexible clinic access. Emphasizing patient support regardless of substance use status helps build therapeutic alliances crucial for long-term engagement and effective HIV care.

Keywords

HIV

substance use disorders

epidemiology

HIV testing

antiretroviral therapy

integrase inhibitors

chemsex

harm reduction

therapeutic alliance