Comparative impact of methamphetamine and other drug use on viral suppression among sexual minority men on antiretroviral therapy. (1st April 2021) - Fulcher, Jennifer A.
Highlights: Methamphetamine use is associated with poor HIV control among sexual minority men on antiretroviral therapy. Poor HIV control remains even after accounting for medication adherence and sociodemographic factors. Other substance use does not have the same association with poor HIV control in this study population. Nearly half of the instances of uncontrolled HIV could be eliminated by stopping methamphetamine use in this population. Abstract: Background: Substance use decreases the likelihood of achieving undetectable HIV viremia; however, the comparative effects by drug have not been fully described. In this study, we compare the effects of methamphetamine use versus other drugs on viremia in sexual minority men on antiretroviral therapy (ART). Methods: HIV-positive participants currently on ART (N = 230) were selected from an ongoing cohort of diverse young sexual minority men (mSTUDY) enrolled from August 2014 to May 2018. Substance use and sociodemographic factors associated with viremia outcomes were assessed using ordinal regression analysis with generalized estimating equations. Viremia outcomes were grouped as undetectable (< 20 copies/mL), low level suppressed (21–200 copies/mL), or not suppressed (>200 copies/mL). Results: The prevalence of drug use across 825 study visits was 73 %, with methamphetamine use most prevalent (50 %). After adjusting for unstable housing and ART adherence, methamphetamine use, either alone (adjusted OR = 1.87; 95 % CI 1.03−3.40) or with other drugs (adjusted OR = 1.82; 95 % CI 1.12−2.95), was associated with higher odds of increasing viremia compared to no drug use. Other drug use excluding methamphetamine did not show a similar association (adjusted OR = 1.29; 95 % CI 0.80−2.09). Among our study population, nearly half the instances of viremia could be reduced if methamphetamine was discontinued (attributable fraction = 46 %; 95 % CI 3–71 %). Conclusions: Methamphetamine use, either alone or in combination with other drugs, is associated with failure of viral suppression among sexual minority men on ART independent of adherence and sociodemographic factors. This accounts for nearly half of the observed instances of unsuppressed viremia in this study.