The Methamphetamine Epidemic: Implications for HIV Prevention and Treatment

San Francisco Department of Public Health, 25 Van Ness Avenue, Suite 710, San Francisco, CA 94102, USA. .
Current HIV/AIDS Reports (Impact Factor: 3.8). 12/2005; 2(4):194-9. DOI: 10.1007/s11904-005-0016-4
Source: PubMed


Methamphetamine and related amphetamine compounds are among the most commonly used illicit drugs, with over 35 million users worldwide. In the United States, admissions for methamphetamine treatment have increased dramatically over the past 10 years. Methamphetamine use is prevalent among persons with HIV infection and persons at risk for HIV, particularly among men who have sex with men. In addition to being associated with increased sexual risk behavior, methamphetamine causes significant medical morbidity, including neurologic deficits, cardiovascular compromise, dental decay, and skin infections, all of which may be worsened in the presence of HIV/AIDS. Methamphetamine use may also result in decreased medication adherence, particularly during "binging" episodes. Behavioral counseling remains the standard of treatment for methamphetamine dependence, although the effectiveness of most counseling interventions has not been rigorously tested. Pharmacologic and structural interventions may prove valuable additional interventions to reduce methamphetamine use.

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    • "General METH use is seen as minimal exposure to the drug, primarily involving first time users; whereas, chronic METH abuse and dependence expose the user to a diverse range of adverse physical and cognitive health consequences (Panenka et al., 2013). The rate of treatment admissions for primary METH abuse has increased over 3-fold in recent years (Colfax and Shoptaw, 2005). Diverse routes for METH use exist, including oral ingestion, smoking, snorting, intravenous injection, and anal insertion. "
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    ABSTRACT: The prevalence of methamphetamine (METH) use is estimated at ~35 million people worldwide, with over 10 million users in the United States. METH use elicits a myriad of social consequences and the behavioral impact of the drug is well understood. However, new information has recently emerged detailing the devastating effects of METH on host immunity, increasing the acquisition of diverse pathogens and exacerbating the severity of disease. These outcomes manifest as modifications in protective physical and chemical defenses, pro-inflammatory responses, and the induction of oxidative stress pathways. Through these processes, significant neurotoxicities arise, and, as such, chronic abusers with these conditions are at a higher risk for heightened consequences. METH use also influences the adaptive immune response, permitting the unrestrained development of opportunistic diseases. In this review, we discuss recent literature addressing the impact of METH on infection and immunity, and identify areas ripe for future investigation.
    Frontiers in Neuroscience 01/2014; 8:445. DOI:10.3389/fnins.2014.00445 · 3.66 Impact Factor
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    • "In the context of HIV infection, methamphetamine use may be a particularly relevant substance of abuse given the high comorbidity rate between these two conditions [17]. "
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    ABSTRACT: The feasibility, use, and acceptability of text messages to track methamphetamine use and promote antiretroviral treatment (ART) adherence among HIV-infected methamphetamine users was examined. From an ongoing randomized controlled trial, 30-day text response rates of participants assigned to the intervention (individualized texting for adherence building (iTAB), n = 20) were compared to those in the active comparison condition (n = 9). Both groups received daily texts assessing methamphetamine use, and the iTAB group additionally received personalized daily ART adherence reminder texts. Response rate for methamphetamine use texts was 72.9% with methamphetamine use endorsed 14.7% of the time. Text-derived methamphetamine use data was correlated with data from a structured substance use interview covering the same time period (P < 0.05). The iTAB group responded to 69.0% of adherence reminder texts; among those responses, 81.8% endorsed taking ART medication. Standardized feedback questionnaire responses indicated little difficulty with the texts, satisfaction with the study, and beliefs that future text-based interventions would be helpful. Moreover, most participants believed the intervention reduced methamphetamine use and improved adherence. Qualitative feedback regarding the intervention was positive. Future studies will refine and improve iTAB for optimal acceptability and efficacy. This trial is registered with NCT01317277.
    AIDS research and treatment 09/2013; 2013(8):585143. DOI:10.1155/2013/585143
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    • "Stimulant use among people with HIV has been associated with more rapid disease progression, including faster progression to AIDS, development of AIDS defining illnesses, and hastened AIDS-related mortality [13]. Studies consistently show that stimulant use is associated with decreased odds of antiretroviral therapy (ART) utilization, poorer ART adherence, difficulties with ART persistence (i.e., duration of time continuously on ART), and elevated HIV viral load [13] [14] [15] [16] [17] [18] [19] [20]. In the era of HIV treatment as prevention (TasP), innovative approaches are needed to promote engagement in HIV care among stimulant users in order to achieve sustained viral suppression and decrease the likelihood of onward HIV transmission to their uninfected sexual partners [21]. "
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    ABSTRACT: Aims of this study were to assess the associations between stimulant use and attitudes toward and engagement in HIV medical care and to examine technology use among stimulant-using and nonstimulant-using men who have sex with men (MSM). HIV-positive MSM (n = 276; mean age = 42 years; 71% white, non-Hispanic; 43% with college degree) completed an online survey in 2009. Most men (69%) had not missed any scheduled HIV medical appointments in the past year, while 23% had missed at least one, and 9% had not attended any appointments. Stimulant use was significantly associated with not attending any HIV medical appointments in the unadjusted model (relative risk ratio (RRR) = 2.84, 95% CI [1.07, 7.58]), as well as in models adjusted for demographic (RRR = 3.16, 95% CI [1.13, 8.84]) and psychosocial (RRR = 3.44, 95% CI [1.17, 10.15]) factors (Ps < 0.05). Fewer stimulant-using than non-stimulant-using men rated HIV medical care a high priority (57% versus 85%; P < 0.01). Few significant differences were found in online social networking or mobile phone use between stimulant-using and non-stimulant-using MSM, even when stratified by engagement in HIV care. Findings indicate that stimulant use is uniquely associated with nonengagement in HIV medical care in this sample, and that it may be possible to reach stimulant-using MSM using online social networking and mobile technologies.
    AIDS research and treatment 06/2013; 2013(11):121352. DOI:10.1155/2013/121352
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