Who Is at Risk for HIV Infection and Which Populations Are Most Affected?
Hepatitis C and Co-Infection with HIV
Anyone can contract HIV, and while IDUs are at great risk because of practices related to their drug use, anyone who engages in unsafe sex (e.g., unprotected sex with an infected partner) could be exposed to HIV infection. However, while all groups are affected by HIV, some are more vulnerable than others, as summarized below. Injection drug use has long been associated directly or indirectly with approximately one-third of AIDS cases in the United States. e fact that IDUs made up only 8 percent of new HIV infections in 2010 versus 23 percent in 1994–2000 demonstrates the progress made in HIV prevention and treatment within this population. Still, much work remains; while there may be fewer new infections among IDUs, in 2009, nearly one-half of those who were HIV+ were unaware they were infected. main way that women contract the virus (see gure), especially within ethnic minority communities. Regional variations of HIV incidence in women have changed over time. In the early years of the epidemic, incidence in women predominated in the Northeast, but infection rates and mortality have been steadily increasing in the southern United States.19 Although injection drug use has declined as a means of HIV transmission over recent years, it is still responsible for 14 percent of HIV diagnoses in women. A recent study conducted by the Massachusetts Department of Public Health reported 40 percent of White women contracted HIV through injection drug use.20 Another factor contributing to HIV disease in women is trauma. Trauma resulting from sexual or physical abuse experienced during childhood or adulthood is increasingly associated with rising prevalence of HIV infection and poor health outcomes in HIV+ women.21 Comprehensive HIV treatment regimens that include mental health services are critical for this population. 12 Heterosexual contact with an HIV+ partner accounted for over one-quarter of all new infections in 2010 and is the
Hepatitis C virus (HCV), a leading cause of liver disease, is highly prevalent among injection drug users and often co-occurs with HIV. In the United States, an estimated 3.2 million people are chronically infected with HCV,22 with injection drug use being the main driver. Nearly one-quarter of HIV patients and over one-half (50–80 percent) of IDUs are infected with both viruses. Chronic HCV and HIV co-infection results in an accelerated progression to end-stage liver disease, with HCV infection being a leading cause of non–AIDS-related deaths among HIV+ individuals. Injection drug use, HIV, and HCV create a complicated tapestry of ailments that present a variety of challenges to healthcare providers. Although HAART medications can e ectively treat people infected with HIV, HAART provides only modest bene t for co-occurring HCV. HCV infection, like HIV infection, can be successfully managed if detected early. e newer HCV medications boceprevir and telaprevir — approved by the U.S. Food and Drug Administration (FDA) in 2011 — increase cure rates and decrease treatment length when combined with standard HCV drug regimens,23 but they must be carefully coordinated with HAART for those co-infected. e added
burden of drug addiction further complicates treatment regimens.
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