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People with HIV (PWH) and comorbid substance-use problems might be among those who would benefit most from long-acting antiretroviral therapy (ART), but they are routinely excluded from phase 3 clinical trials. Their inclusion would permit an examination of the clinical value of long-acting therapies for people with adherence problems, and an exploration of syndemic interactions between HIV, mental-health conditions, and substance-use problems, which compound into a major challenge in the efforts to end the HIV epidemic.Syndemic theory is a useful biopsychosocial framework for understanding the higher prevalence of mental-health conditions and substance-use problems among PWH.

患有艾滋病毒（PWH）和合并药物使用问题的人可能是从长效抗逆转录病毒疗法（ART）中受益最多的人之一，但他们通常被排除在3期临床试验之外。他们的加入将允许检查长效疗法对有依从性问题的人的临床价值，并探索艾滋病毒，心理健康状况和药物使用问题之间的综合相互作用，这将成为结束艾滋病毒流行努力的主要挑战。综合理论是一个有用的生物心理社会框架，用于了解PWH中心理健康状况和物质使用问题的较高患病率。

The theory holds that it is essential to examine the synergy of coexisting epidemics in order to explain the confluence of factors that lead to vulnerabilities and the emergence of disease. Given that social factors strongly influence vulnerability to infection, and that infections interact (as with HIV and hepatitis C virus coinfection) at the biological level to accelerate disease progression, syndemic theory argues that the development and accumulation of psychosocial health problems will interact further to exert a synergistically negative impact on health1 and infection outcomes.

该理论认为，必须研究共存流行病的协同作用，以解释导致脆弱性和疾病出现的因素的汇合。鉴于社会因素强烈影响感染的易感性，并且感染在生物学水平上相互作用（如艾滋病毒和丙型肝炎病毒合并感染）以加速疾病进展，综合理论认为，心理社会健康问题的发展和积累将进一步相互作用，对健康和感染结果产生协同负面影响。

Although studies have shown that a greater accumulation of psychosocial conditions — such as depression, violence victimization, hazardous alcohol use, and/or drug use — is additively associated with higher rates of HIV transmission and worse health outcomes among PWH1, evidence from these same individual-level data to support synergistic interactions between psychosocial conditions is limited2.

虽然研究表明，心理社会状况（如抑郁症，暴力受害，危险酒精使用和/或药物使用）的积累与PWH1中艾滋病毒传播率较高和健康状况较差有关，但来自这些相同个体水平数据的证据支持心理社会状况之间的协同相互作用是有限的2。

However, studies have not routinely explored how interactions with or between biological factors affect health outcomes, or.

然而，研究并没有经常探讨生物因素之间的相互作用如何影响健康结果，或者。

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Download referencesAcknowledgementsWe thank M. Kaul, C. Achim and A. Lin for their input. M.C.G.M. is funded by National Institutes of Health (NIH) grants R01 DA058405 and R61DA059924. Other authors are supported by NIH grant P30 MH062512.Author informationAuthor notesThese authors contributed equally: David J.

下载参考文献致谢我们感谢M.Kaul，C.Achim和A.Lin的投入。M、 C.G.M.由美国国立卫生研究院（NIH）资助R01 DA058405和R61DA059924。其他作者得到了美国国立卫生研究院资助P30 MH062512的支持。作者信息作者注意到这些作者做出了同样的贡献：David J。

Grelotti, Maria Cecilia Garibaldi Marcondes, Mariana Cherner.Authors and AffiliationsDepartment of Psychiatry, University of California San Diego School of Medicine, San Diego, CA, USADavid J. Grelotti, Jessica Montoya, Jennifer Iudicello, Ronald Ellis, Igor Grant, Scott Letendre & Mariana ChernerHIV Neurobehavioral Research Program, University of California San Diego, San Diego, CA, USADavid J.

格雷洛蒂，玛丽亚·塞西莉亚·加里波第·马孔德斯，玛丽安娜·切纳。作者和附属机构加利福尼亚大学圣地亚哥医学院精神病学系，加利福尼亚州圣地亚哥，美国David J.Grelotti，Jessica Montoya，Jennifer Iudicello，Ronald Ellis，Igor Grant，Scott Letendre＆Mariana Cherneriv神经行为研究计划，加利福尼亚大学圣地亚哥分校，加利福尼亚州圣地亚哥，美国David J。

Grelotti, Jessica Montoya, Jennifer Iudicello, Ronald Ellis, Igor Grant, Scott Letendre & Mariana ChernerOwen Clinic, University of California San Diego, San Diego, CA, USADavid J. Grelotti, Jessica Montoya & Scott LetendreSan Diego Biomedical Research Institute, San Diego, CA, USAViolaine Delorme-Walker & Maria Cecilia Garibaldi MarcondesAuthorsDavid J.

Grelotti，Jessica Montoya，Jennifer Iudicello，Ronald Ellis，Igor Grant，Scott Letendre＆Mariana ChernerOwen Clinic，加利福尼亚大学圣地亚哥分校，加利福尼亚州圣地亚哥，美国David J.Grelotti，Jessica Montoya＆Scott LetendreSan Diego生物医学研究所，加利福尼亚州圣地亚哥，美国维奥琳·德洛姆·沃克和玛利亚·塞西莉亚·加里波第·马孔德·索索索索斯达维德J。

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David J. Grelotti, Scott Letendre, Maria Cecilia Garibaldi Marcondes or Mariana Cherner.Ethics declarations

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Rights and permissionsReprints and permissionsAbout this articleCite this articleGrelotti, D.J., Montoya, J., Delorme-Walker, V. et al. On the issue of treating HIV in people with syndemic mental-health and substance-use disorders.

权利和许可本文引用了这篇文章Grelotti，D.J.，Montoya，J.，Delorme Walker，V。等人关于治疗患有综合性心理健康和药物使用障碍的人的艾滋病毒问题。

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