PerspectiveIn the Journals

ART beneficial for MSM with HIV reporting stimulant use

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October 16, 2014

Antiretroviral therapy had benefits for HIV-positive men who have sex with men reporting stimulant use compared with non-users, according to recently published data.

“Patients with HIV who use stimulants and other substances often experience difficulties with accessing ART, partially due to the concerns of health care providers that they will not be able to take their medications as directed,” Adam W. Carrico, PhD, of the University of California, San Francisco, said in a press release. “Findings from this study demonstrate that many stimulant users take their ART at levels sufficient to avoid negative clinical outcomes.”

Carrico and colleagues examined the records of MSM with HIV enrolled in the Multicenter AIDS Cohort Study (n=1313) from 1996 to 2012, some of which reported stimulant use (n=341). The cumulative proportion of study visits with reported stimulant use was compared with cases of all-cause mortality and AIDS or all-cause mortality.

Researchers found no significant association between any level of stimulant use and all-cause mortality. A competing risks analysis also indicated that no level of stimulant use was associated with increased mortality, AIDS-related or not.

“When we look at overall mortality, ART leads to similar clinical benefits for both stimulant users and non-users, notwithstanding stimulant use,” Carrico said in the release.

Of the men with HIV who did not have AIDS upon initiating ART (n=648), however, reporting stimulate use at 50% or more study visits was associated with increased odds of progression to AIDS or all-cause mortality (adjusted OR=1.54; 95% CI, 1.02-2.33).

“If we are to achieve the goals of the President’s National HIV/AIDS Strategy and UNAIDS to end the HIV/AIDS epidemic, we will need to treat HIV-positive active substance users for their HIV while encouraging them to stop or reduce their substance use,” Carrico said in the release. “Programs integrating substance abuse services with HIV clinical care may both improve health outcomes for patients and reduce new infections.”

Disclosure: The researchers report no relevant financial disclosures.

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Joel Gallant

Joel Gallant

This study from the Multicenter AIDS Cohort study found that among MSM receiving antiretroviral therapy, the overall risk for mortality among those using stimulants such as methamphetamine was no higher than it was for non-stimulant users, although there was a modestly increased risk of disease progression or mortality among those who had never been diagnosed with AIDS.  This study points out that ART works when it’s taken, and many people can be adherent with therapy despite ongoing substance use. Substance use should not be viewed as a contraindication to starting ART, though it has been shown to increase the risk of non-adherence.

It’s worth pointing out that this study looked only at men who had initiated ART.  Men who never started ART due to substance use would not have been included in the analysis, and would presumably have higher rates of progression and mortality than those taking ART.

Joel Gallant, MD, MPH
Chair of the HIV Medicine Association
Associate medical director of specialty services, Southwest CARE Center

Disclosure: Gallant reports relationships with Bristol-Myers Squibb, CytoDyn Inc., Gilead Sciences, Janssen Therapeutics, Merck, Sangamo BioSciences, Takara Bio Inc., Vertex Pharmaceuticals and ViiV Healthcare.