February 21, 2008

Drug Use Linked to Infection With Resistant Virus

Gay and bisexual men who used ecstasy, GHB and/or crystal were more likely to be infected with HIV that is resistant to antiretroviral drugs, say the authors of a study to be published in a forthcoming issue of the Journal of Acquired Immune Deficiency Syndromes.

Pamina Gorbach, MHS, DrPH, of the School of Public Health at the University of California, Los Angeles, and her colleagues administered surveys between 2002 and 2006 to 117 men who have sex with men (MSM) who had been recently infected with HIV. The average age of the participants was 35 years and 71 percent identified as white.

Of 112 who had a genotypic resistance test, 12.5 percent were infected with HIV resistant to at least one class of antiretrovirals. Of the 117 who had a phenotypic resistance test conducted, 14 percent were found to have resistant virus.

Fifty-one percent of the men reported substance use during sexual activity in the 12 months before being surveyed. Men who used drugs during sex were more than four times as likely to be infected with drug-resistant virus, compared with men who did not use drugs during sex. Men who used more than one drug during sex were nearly six times more likely to be infected with drug-resistant virus.

The drugs most strongly associated with being infected with resistant virus were MDMA (ecstasy), gamma-hydroxybutanol (GHB) and crystal methamphetamine, with ecstasy and GHB users being nearly seven times more likely to have drug-resistant virus and crystal users over four times as likely. Alcohol, the most commonly used recreational substance among MSM, was not reported in the study results.

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David G Ostrow, Chicago, 2008-03-27 16:31:46
I assume that this study was based, at least in part, on the UCLA MACS data. If so, do we have similar data from the other MACS sites that could be used to validate this findings? Could someone please send me a pdf of the complete article? Thanks

Pamina Gorbach, , 2008-03-26 11:14:12
Hi Guys - Let me clarify - this was a study of recently infected men who were not yet on medication for their HIV who had acquired a resistant virus. So while adherence does affect the likelihood of developing resistance, in this study all these were men who were infected with a resistent virus - so drug use played a role in who got infected with a resistent strain of the virus and adherence could not have paid a role since they were not yet on medication. I hope this helps! Pamina Gorbach

Robert Bolan, M.D., Los Angeles, 2008-02-27 15:53:00
Probably Sean's explanation is correct. Our patients tell us that when they are using drugs or alcohol their medication adherence goes way down. It's also possible that some recreational drugs may interact with some HIV meds, decreasing their levels below what is needed for viral suppression.

Sean, London, 2008-02-23 03:10:28
Is it possible that the use of recreational drugs is making people forget to take their meds which is the real reason why resistance is more common in these groups?