High rates of meth use seen in California HIV clinic; Connected to HIV outcomes

Methamphetamine use was common among people living with HIV—and was associated with worse HIV outcomes, as well as coinfection with other sexually transmitted diseases—in a chart review of a large urban HIV clinic in California.

About This Study

“Impact of methamphetamine use on HIV and other health outcomes at an urban HIV medicine clinic” was published online on July 3, 2024, in AIDS. The lead author is Laura Bamford, M.D., M.S.C.E., of the University of California San Diego.

Key Research Findings

Researchers reviewed the medical charts of 3,092 people living with HIV who attended a single urban HIV clinic in California to determine how many participants used methamphetamine, who was more likely to use the substance, and whether HIV outcomes differed between those who did or did not use the drug. Median participant age was 53 years, 88% of participants identified as men, 53% were white, and 26% were Latinx.

Methamphetamine use was recorded for 519 participants, resulting in a prevalence of 17%. Compared to participants not using meth, participants using the substance were more likely to be younger, white, lesbian/gay or bisexual, or residing in neighborhoods with poor social determinants of health. Between 1% and 12% of the 179 participants whose urine tested positive for methamphetamine during the study period also tested positive for one or more additional street drugs, including fentanyl. Methamphetamine use was also associated with a greater likelihood of coinfection with hepatitis C, gonorrhea, or chlamydia.

Methamphetamine use was associated with missed HIV care visits, lower likelihood of viral suppression, and greater likelihood of a low CD4 count. For example, those with evidence of methamphetamine use missed 17% of HIV primary care visits, while those without evidence of use missed 7% of visits. When evaluating CD4 counts, 11% of those with a history of methamphetamine use had a CD4 count <200 cells/mm³, compared to 4% of those without, while 87% of those with a methamphetamine history had a suppressed viral load (<200 copies/ml) versus 95% for those without the methamphetamine history.

In addition, 12% of participants who used methamphetamine and 6% of participants who did not use it screened positive for major depressive disorder. However, 25% of participants with evidence of meth use and 21% without refused that screening.

Discussion Highlights and Implications for Practice

Study limitations reported included a reliance on medical charts, which may have underestimated methamphetamine use, and the retrospective design, which precludes inferences about causality.

The worse HIV outcomes among people living with HIV who use methamphetamine not only impact their own health but also increase the chances that the virus will be passed on to others, the authors said.

Integrating harm reduction strategies, as well as both pharmacological and behavioral substance use treatment, into HIV care may improve prevention efforts. For such treatment to be effective, mental health conditions also need to be addressed, the researchers noted. The study authors also called for more research into the efficacy of different substance use treatment strategies among people living with HIV.

By Barbara Jungwirth