THE SUBSTANCE-USING HUMAN-IMMUNODEFICIENCY-VIRUS PATIENT - APPROACHESTO OUTPATIENT MANAGEMENT

Individuals with a substance use disorder who are infected with human immunodeficiency virus (HIV) provide physicians with challenging issue s for both medical management and drug treatment. Using a case present ation format, we present an overview of some of the major issues invol ved in delivering effective primary care for these individuals. A deta iled medical and substance use history is critical to sort common comp laints that can be seen both in HIV infection and with drug use. Physi cians must be able to recognize withdrawal syndromes and differentiate those signs and symptoms that may be attributed to specific drugs. A two-phase model of drug abuse treatment takes into account both detoxi fication and maintenance of abstinence. Primary care physicians should be able to initiate the process of substance abuse treatment and refe r the patient to appropriate substance abuse programs when necessary. Pharmacological approaches to long-term abstinence with heroin addicti on include methadone, LAAM, and naltrexone. While clinically challengi ng, HIV-infected substance users can be successfully managed using the general principles of primary care.