Crystal Methamphetamine Injection Predicts Slower HIV RNA Suppression among Injection Drug Users
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Transcript of Crystal Methamphetamine Injection Predicts Slower HIV RNA Suppression among Injection Drug Users
Crystal Methamphetamine Injection Predicts Slower HIV RNA
Suppression among Injection Drug Users
Nadia Fairbairn1
Thomas Kerr1, 2
M-J Milloy1
Ruth Zhang1
Julio Montaner1, 2
Evan Wood1, 2
1 Urban Health Research Initiative of the British Columbia Centre for Excellence in HIV/AIDS
2 Division of AIDS, Department of Medicine, University of British Columbia
• Crystal methamphetamine is a stimulant drug with higher purity than powdered methamphetamine
• Reports of increasing crystal methamphetamine production and consumption globally
• Major implications for HIV prevention and treatment strategies
Background
Amphetamine-type stimulant seizures in 2008
UNODC World Drug Report 2010
• 66% Bangkok injection drug users (IDUs) reported injecting methamphetamine (Werb et al., 2009)
• Methamphetamine injection associated with HIV risk behavior syringe sharing in Bangkok (Hayashi et al., IAC 2010 WEPE0269)
• Australia and the U.S. have documented increases in crystal methamphetamine injection among drug users
Background
• Injection and non-injection crystal methamphetamine use increasing in Vancouver, Canada
Background
Fairbairn et al., 2007
• Crystal methamphetamine use linked to: • Sexual risk behaviors• Increased likelihood of HIV seroconversion• Poor adherence to antiretroviral therapy
• Injection of crystal methamphetamine associated with syringe sharing
• Not much known about the impact of crystal methamphetamine use on the outcomes of HIV treatment
Background
Objective
• To examine the association between crystal methamphetamine injection and plasma HIV RNA suppression among a cohort of HIV-positive injection drug users initiating ART
Methods
• The ACCESS cohort is an ongoing prospective cohort of HIV-positive individuals who inject drugs
• Participants recruited through self-referral and street outreach from Vancouver’s Downtown Eastside since 1996
• At baseline and semi-annually participants provide blood sample and complete questionnaire
Methods• Primary endpoint of analysis: time to plasma viral
load suppression <500 copies/mL from start of ART
• Primary independent variable of interest: use of injection crystal methamphetamine
• Variables: Daily heroin and cocaine injection, crack smoking Gender, age, ethnicity Baseline viral load (per log10) Baseline CD4 cell count (per 100 cells/mm3)
• Multivariate model fit using an a priori defined model-building approach
Have you injected crystal methamphetamine in the last 6 months?
Yes No Yes
No90.6%
Results• Sample characteristics (n=708):
384 (54.2%) ART-naïve participants initiated HAART 163 (42.5%) female respondents Median follow-up 18 months (inter-quartile range 6 - 49)
36 (9.4%)reported crystal meth injection at any time during follow-up.
ACCESS Cohort (n=708)
• Primary outcome of interest:
HIV RNA Suppression Baseline Viral
Load0.86(0.73 – 1.00)
p = 0.064
Adjusted** Relative Hazard(95% CIs)
Baseline CD4 Count 0.90(0.84 – 0.96)
p < 0.001
Crystal methamphetamine injection*
* Behaviors refer to activities in the last 6 months.
** Model was also adjusted for age, heroin injection and cocaine injection.
• Multivariate Cox Regression analyses
0.63(0.40 – 0.98)
p = 0.039
Multivariate Cox Regression analysis of factors independently associated with time to HIV RNA suppression <500 copies/mL.
Interpretations
• Crystal methamphetamine injection independently and negatively associated with plasma HIV RNA suppression
• Psychopharmacological effects of crystal methamphetamine may undermine antiretroviral treatment adherence
• Some evidence for direct effects on HIV disease progression
Interpretations
• Crystal methamphetamine production is a highly profitable and easily concealable endeavor
• Demand for the drug is increasing
• Legal remedies and law enforcement may have negligible impact on use
• Urgent need for evidence-based HIV prevention and treatment programs for crystal methamphetamine injectors
Limitations
• Findings possibly conservative due to socially desirable reporting
• Sample not randomly selected, findings may not generalize to other IDU
• Further research needed to examine impact of methamphetamine use on HIV pathogenesis
Conclusion
• These findings contribute further evidence to the negative health outcomes associated with crystal methamphetamine use
• Expansion of treatment programs and implementation of novel interventions for crystal methamphetamine injectors urgently needed
Acknowledgements
• ACCESS participants• ACCESS investigators and staff: Deborah
Graham, Tricia Collingham, Caitlin Johnston, Steve Kain, and Calvin Lai
• US National Institutes of Health • Canadian Institutes of Health Research