Methamphetamine use curbs efficacy of HAART for HIV infection

NEW YORK (Reuters Health) - Increased HIV loads in current methamphetamine users on HAART (highly active antiretroviral therapy) suggest that the drug reduces the effectiveness of such therapy, researchers report in the December 15th issue of the Journal of Infectious Diseases.

However, lead investigator Dr. Ronald J. Ellis told Reuters Health that the study also "demonstrates that HIV-infected former methamphetamine users in sustained recovery—that is, no longer using methamphetamine—can successfully undertake treatment with complex antiretroviral medications regimens."

Dr. Ellis of the University of California San Diego and colleagues note that in cell cultures and in animal models methamphetamine accelerates retroviral replication.

To determine whether this might also be true in humans, the researchers studied a total of 230 HIV-positive volunteers, more than half of whom were receiving HAART.

They were classified as being current methamphetamine users with positive urine tests, previous users who had been abstinent for at least 30 days and had negative urine tests, and controls who had never been methamphetamine dependent and also had negative urine test results.

Plasma viral loads were significantly higher in current users than in those in the other two groups. There was a similar, but non-significant, trend in virus loads in cerebrospinal fluid.

However, it was also established that virus loads were significantly greater only in those current users who reported receiving HAART. In the other two groups, HAART was effective in suppressing viral replication.

The researchers therefore conclude that methamphetamine and HAART interact and that "abstinence programs are a key component of effective treatment of HIV in methamphetamine-abusing populations."

Nevertheless, Dr. Ellis added, "the study also indicates that fears that methamphetamine can intensify HIV replication in humans appear to be unfounded."

J Infect Dis 2003;188:1820-1826.