HIV disease in the intravenous drug user: role of the primary care physician

Intravenous drug users (IVDUs) are increasingly encountered in the medical arena, on both an inpatient and an outpatient basis, in large part because of complications related to the human immunodeficiency virus (HIV). Clinicians must work to overcome long-standing antipathy towards this population in order to provide appropriate care, as well as to develop an understanding of the process of addiction and of the addict as a patient. The use of relationship skills, limit setting, and contingency contracting and an ability to choose and gain access to appropriate and/or available chemical dependency treatment options are important in the care of these patients. Finally, an adequate biomedical knowledge base of the medical complications of IVDUs, as well as the care of drug-related complications and withdrawal and overdose syndromes, is necessary to provide optimal care. In addition, the IVDU may have certain features of HIV-related disease that differ from those of other groups, and the clinician must be familiar with these features. Provision of such care is within the scope of the primary care clinician and can improve patient retention in treatment and the outcomes of such treatment, as well as both patient and clinician satisfaction.