Antiretroviral Guidelines

US DHHS Guidelines with Autralian commentary

Substance Use Disorders and HIV

Last Updated: July 10, 2019; Last Reviewed: July 10, 2019

Key Considerations and Recommendations

  • Substance use disorders (SUDs) are prevalent among people with HIV and contribute to poor health outcomes; therefore, screening for SUDs should be a routine part of clinical care (AII).
  • The most commonly used substances among people with HIV include alcohol, benzodiazepines, cannabinoids, club drugs, opioids, stimulants (cocaine and methamphetamines), and tobacco.
  • Health care providers should be nonjudgmental when addressing substance use with their patients (AIII).
  • Persons with HIV and SUDs should be screened for additional mental health disorders (AII).
  • Persons with HIV and SUDs should be offered evidenced-based pharmacotherapy (e.g., opioid agonist therapy, tobacco cessation treatment, alcohol use disorder treatment; see Table 13) as part of comprehensive HIV care in HIV clinical settings (AI).
  • Ongoing substance use is not a contraindication to antiretroviral therapy (ART) (AI). Persons who use substances can achieve and maintain viral suppression with ART.
  • Substance use may increase the likelihood of risk-taking behaviors (e.g., risky sexual behaviors), the potential for drug-drug interactions, and the risk or severity of substance-associated toxicities (e.g., increased hepatotoxicity or an increased risk of overdose).
  • Selection of ART regimens for individuals who practice unhealthy substance and alcohol use should take potential adherence barriers, comorbidities which could impact care (e.g., advanced liver disease from alcohol or hepatitis viruses), potential drug-drug interactions, and possible adverse events associated with the medications into account (AII).
  • ART regimens with once-daily dosing of single-tablet regimens, high barriers to resistance, low hepatotoxicity, and low potential for drug-drug interactions are preferred (AIII).
    Rating of Recommendations:  A = Strong; B = Moderate; C = Optional
    Rating of Evidence:  I = Data from randomized controlled trials; II = Data from well-designed nonrandomized trials or observational cohort studies with long-term clinical outcomes; III = Expert opinion