Comments on an article by M. -J. Milloy et al. (see record 2012-07114-005). Milloy et al. make a key contribution in understanding the role of 2 environmental factors, involvement in the sex trade and incarceration, in undermining antiretroviral therapy (ART) success among people who use drugs (PWUD). Consistent with previous results, the authors also show that receiving methadone treatment during ART significantly improves long-term virological response to ART for those who are opiate dependent. Illicit drug use per se was not associated with viral rebound in this study, a finding that requires widening the analytical frame beyond the usual focus on individual behavior and biological markers to the broader causes of ART interruptions and treatment failure among PWUD. The findings by Milloy et al. suggest new directions and underscore the importance of reexamination of multi cohort analyses that have focused primarily on whether individuals used drugs and other individual determinants of HIV treatment outcomes. The study by Milloy et al. gives us an important lesson about how such research can be done. (PsycINFO Database Record (c) 2015 APA, all rights reserved).
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