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Adherence and antiretroviral therapy in injection drug users.

The intertwined epidemics of human immunodeficiency virus (HIV) infection and chemical dependency continue to be a challenge for optimal medical care delivery in the era of potent antiretroviral therapy. In this issue of JAMA, Celentano et al 1 report a cross-sectional survey in 404 injecting drug users (IDUs) with HIV infection in Baltimore, Md, from mid-1996 to mid-1997 in which only 57 (14%) of 404 patients reported receiving potent antiretroviral therapy. Sixty-three percent of patients reported receiving no (49%) or inadequate (14%) therapy. Active injecting drug use, lack of advanced disease (acquired immunodeficiency syndrome [AIDS]), not being in a substance abuse treatment program, and not having a usual source of primary care or health insurance were associated with not receiving therapy.