Injection-drug use has become an important risk factor for infectionwith the human immunodeficiency virus (HIV), and HIV infectionhas become well established among drug users in North America,Europe, South America, and Southeast Asia1,2,3. In the UnitedStates, approximately 34 percent of all the cases of the acquiredimmunodeficiency syndrome (AIDS) in adults have occurred eitherin injection-drug users or in their sexual contacts. The proportionof the AIDS epidemic that is related to injection-drug use hasincreased steadily over the past decade,2,3 and it is particularlyhigh among women and ethnic minorities3. In addition, the spectrum. . . [Full Text of this Article]
Screening for and Diagnosis of Substance Abuse
History
Physical Examination
Laboratory Tests
The Spectrum of HIV-Related Diseases in Injection-Drug Users
Bacterial Infections
Tuberculosis
Sexually Transmitted Diseases
Hepatitis
Other Retroviral Infections
Cancer
Revised Case Definition of AIDS
Substance Abuse and the Differential Diagnosis of HIV-Related Symptoms
Constitutional Symptoms
Pulmonary Symptoms
Neurologic Symptoms
Dermatologic and Other Symptoms
Clinical Issues in the Care of Injection-Drug Users with HIV Infection
Preventive Health Care
Referral of Patients for Treatment of Substance Abuse
Drug Interactions
Issues in Women's Health Care
Psychosocial Issues in the Care of Injection-Drug Users with HIV Infection
Access to Care and Compliance with Treatment
Psychiatric Illness and Cognitive Dysfunction
Prescription of Psychoactive Medications
Physician-Patient Interactions
Potential Conflicts
Productive Physician-Patient Interactions
Challenges for the Future
Source Information
From the Departments of Medicine (P.G.O., P.A.S.) and Psychiatry (R.S.S.), Yale University School of Medicine, New Haven, Conn.
Address reprint requests to Dr. O'Connor at the Primary Care Center, Yale University School of Medicine, P.O. Box 208025, New Haven, CT 06520-8025.
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