The availability of HAART since 1996 has had a dramatic effect on the face of HIV AIDS. HAART is a customized combination of different classes of medications that a physician prescribes based on such factors as the patient’s viral load, CD4⁺ lymphocyte count, and clinical symptoms. CD4⁺ lymphocytes are white blood cells that HIV infects and kills, leading to a weakened immune system and AIDS. Though not a cure, HAART controls viral load, helping to delay the onset of symptoms and achieve prolonged survival in people diagnosed with HIV/AIDS.

With HAART the medical implications that HIV has have been changed. New diagnoses of HIV-associated infections and some neurological complications, such as HIV dementia, have decreased since its introduction. Other neurological problems associated with long term use of this therapy include nerve damage. HAART is reported to have an effect to increase lipid (fat) levels in the blood, changed glucose metabolism and other complications.

Interactions with HAART and other medications used in the treatment of addiction may hurt both treatments. For example, methadone blood concentration drops as a result of the components in HAART therapy. There is currently research to determineif buprenorphine which is a treatment for opioid addictions has similar problems.

One issue for people treated with HAART is sticking to the medication regimen which is needed to benefit from HAART. Staying to the regimen can be hard for drug user’s lifestyles, due to their chaotic life styles. In addition, because HAART reduces viral load, some patients mistakenly believe that they do not need to adhere to the HIV treatment regimen or that reduced viral load means elimination of the risk of transmission of HIV/AIDS. This idea can lead to a resuming of old high risk behaviors, including use of dirty needles and unsafe sex. NIDAsupported research has helped to improve HIV outcomes among IDUs and has advanced new discoveries and approaches for treating medical consequences resulting from living longer with the disease.

The following laboratory tests should be performed for a new patient during initial patient visits:

•  HIV antibody testing (if prior documentation not available) or if HIV RNA is undetectable (AI);
•  CD4 T-cell count (AI);
•  Plasma HIV RNA (viral load) (AI);
•  Complete blood count, chemistry profile, transaminase levels, BUN and creatinine, urinalysis, screening test
for syphilis (e.g., RPR, VDRL, or treponema EIA), tuberculin skin test (TST) or interferon-? release assay
IGRA (unless there is history of a prior TB or positive TST or IGRA), anti Toxoplasma gondii IgG,
hepatitis A, B, and C serologies, and Pap smear in women (AIII);
– Fasting blood glucose and serum lipids if the person is considered to be at risk for heart disease and for
baseline evaluation prior to initiation of combination antiretroviral therapy (AIII); and
• For patients who have pretreatment HIV RNA >1,000 copies/mL, genotypic resistance testing when the
patient enters into care, regardless of whether therapy will be initiated immediately (AIII). For patients who
have HIV RNA levels of 500–1,000 copies/mL, resistance testing also may be considered, even though
amplification may not always be successful (BII). If therapy is deferred, repeat testing at the time of
antiretroviral initiation should be considered (CIII).

Patients living with HIV infection must often cope with multiple social, psychiatric, and medical issues that are best
adressed with a multidisciplinary approach to HIV. The evaluation also must include assessment of
substance abuse, economic factors (e.g., unstable housing), social support, mental illness, comorbidities, high-risk behaviors, and other factors that are known to impair the ability to adhere to treatment and to promote education about HIV Once evaluated, these factors should be managed accordingly.
Lastly,  risk behaviors and effective strategies to prevent HIV transmission. to others should be
provided at all a patient’s clinical visits.