Amphetamine use associated with higher viral load in PLWH, irrespective of adherence

Amphetamine use was correlated with higher viral load among men who have sex with men (MSM) and transgender women in a study conducted in Atlanta, Georgia. The study authors found that the findings could not be explained by poor adherence to antiretroviral therapy (ART) alone.

About This Study

“Amphetamine use and its associations with antiretroviral adherence and viral load among sexual minority men and transgender women living with HIV” was published online on May 3, 2023, in AIDS Care. The lead author is Natalie M. Brousseau, Ph.D. , of the Institute for Collaboration on Health, Intervention, and Policy at the University of Connecticut in Storrs, Conn.

Key Research Findings

This study, part of a clinical trial, assessed the direct and indirect effects of various substances on viral load in 385 MSM and transgender women living with HIV in metropolitan Atlanta, Georgia. Participants’ average age was 29 years and 90% of participants were Black. Based on urinalysis, 75% of participants used cannabis, 29% used alcohol, 17% cocaine, 14% methamphetamines, and 12% tested positive for amphetamines.

Compared to other or no substances, participants who used amphetamines had significantly higher viral loads, and used more cocaine, but less cannabis. There was both a direct correlation between amphetamine use and HIV viral load and an indirect one through worse ART adherence. Participants using amphetamines also reported receiving more substance use counseling than MSM/trans women who used other mood-altering drugs.

No association between ART adherence or viral load and cocaine or alcohol use was found. Cannabis use was negatively associated with adherence but not with viral load.

Discussion Highlights and Implications for Practice

The study authors pointed out that the sample size was not large enough to determine the effects of various combinations of multi-substance use.

Other study limitations included the use of a point-of-care urine dip test (Ethyl glucuronide) to determine recent alcohol use. Self-report and other longitudinal measurements may be needed to ascertain patterns and periods of heavy/heavier use, the authors observed.

The researchers recommended that interventions targeting substance use need to distinguish between the various mood-altering drugs and interventions may need to be tailored accordingly. Reducing alcohol or cannabis use improves adherence, which affects viral load, they noted; however, better adherence–e.g., through long-acting antiretrovirals–may not be enough to counteract the effects of stimulants on viral load, they cautioned.