At this year’s International AIDS Society Conference from July 19 to 22, scientists, researchers and policymakers discussed how to end AIDS once and for all. The general consensus among the HIV research community is that to achieve this goal addictions must be addressed and treated, and harm reduction strategies implemented. The opening conference keynote by Dr. Nora Volkow focused on the importance of integrating HIV and addiction treatment.
Dr. Nora Volkow has been head of the National Institute on Drug Abuse (NIDA) at the US National Institutes of Health (NIH) since 2003. Dr. Volkow’s work has been instrumental in demonstrating that drug addiction is a disease of the human brain. As a research psychiatrist and scientist, Dr. Volkow pioneered the use of brain imaging to investigate the toxic effects and addictive properties of drugs of abuse. Her studies have documented changes in the dopamine system affecting, among others, the functions of frontal brain regions involved with motivation, drive and pleasure in addiction. She has also made important contributions to the neurobiology of obesity, ADHD, and aging. Dr. Volkow has published more than 580 peer-reviewed articles and written more than 90 book chapters and non-peer reviewed manuscripts, and has also edited three books on neuroimaging for mental and addictive disorders.
The BC-CfE sat down to speak with Dr. Volkow in Vancouver.
- What are you most looking forward to at this year’s International AIDS Society Conference? What is the significance of this conference on the international stage?
I am always looking forward to hearing about scientific discoveries that spur the development of an effective HIV cure. Indeed, there is a very high expectation that recent advances have a good chance of helping us realize that goal. The second aspect I am looking forward to is getting the pulse on countries’ strategies. For example, we have established a partnership with China and Vietnam to implement medically assisted therapy in ways that can improve their outcomes in addictions and also HIV. Also, I am interested in the intersection between alcohol addiction and HIV, as it relates to the clinical outcomes of those living with an HIV infection. In general, I don’t think this is an area that has attracted much attention, even though alcoholism is likely a major contributor to increased risk behaviours. That aspect of drug intoxication – whether it’s methamphetamines or alcohol – is one that we haven’t paid much attention to but one that BC has always been at the forefront of.
- This year’s conference will feature research on the intersections between addiction or drug use, and HIV/AIDS and viral hepatitis. How could addressing the health of those with addictions help curb the spread of communicable diseases?
The contribution of drugs to the HIV epidemic is twofold. First, is the impact drug use has on the emergence of new cases of HIV, and second, its influence on treatment outcomes. If someone is taking drugs constantly, or on a daily basis, the risk of infection goes up. One of the best known consequences of repeated drug use is the reduced performance in areas of our brain that regulate self-control. This erosion of the capacity to exert self-control helps explain why people who use drugs tend to engage in high-risk behaviours, such as sharing needles or engaging in high-risk sexual practices, when they take those drugs.
For the treatment component, we know that people who take drugs are much less likely to be adherent. This is one of the reasons why it’s so important to initiate treatment for substance abuse at the same time that you initiate antiretroviral therapy. Study after study has shown that adherence suffers when addictions are not treated. Within the United States, rates of HIV have remained stable at about 48,000 new cases each year. So, I wonder to what extent is our inability to bring down these numbers related to not properly implementing evidence-based practices for the treatment and testing for addicted individuals. One of the areas for the implementation cascade that we are very interested in following is the model of British Columbia on addiction treatment.
- In British Columbia, there has been enormous success in reducing the rate of HIV by coupling the Treatment as Prevention¨ strategy, which provides early and full access to HIV treatment, with harm reduction, such as needle exchange programs and supervised injection facilities. Do you see progress happening in other locations or jurisdictions using these approaches?
Yes, definitely. A good example would be Brazil, because their approach for implementing it included a very aggressive way of expanding ART (antiretroviral therapy) while at the same time seeking out injection drug users. We at NIDA have been encouraging countries to adopt such practices – such as China and Vietnam. Vietnam is very interested in exploring medically assisted therapies. We are also attempting in the US to understand what kinds of medications will help those with addictions remain adherent to ARV.