The odds of viral suppression significantly increased over time among PLWH who only used stimulants such as methamphetamine intermittently, but not among those who used such substances consistently, a San Francisco, California, study published in the Journal of Acquired Immune Deficiency Syndromes found.
All 1,635 participants were on antiretroviral treatment (65% at enrollment and 35% during follow-up) and were followed for a median of 2.3 years. The majority were white (57%); male (87%); and identified as being part of a sexual minority (78%). Median age was 45 years at study entry. Data were divided into pre-universal treatment era (2000-2009) and universal treatment era (2010-2016); 2010 was the year San Francisco adopted a "test and treat" policy in which immediate treatment initiation was recommended for all people newly diagnosed with HIV in the city.
Cumulative stimulant use declined over time (0.8% decrease per year in the cohort), especially during the universal treatment era. Higher levels of cumulative stimulant use were significantly predictive of fewer years spent with a suppressed viral load, but participants with a moderate level of stimulant use -- i.e., usage was reported during 50% of a participant's study visits -- still had a statistically significant greater likelihood of achieving a suppressed viral load over time. The same could not be said for participants who reported stimulant use during 100% of their study visits: Although a trend toward greater viral suppression was seen, the findings did not reach statistical significance.
Results show that antiretroviral treatment should be started in people who use stimulants while also delivering substance use interventions, study authors concluded. They called for further research among more diverse cohorts to determine the odds of viral suppression among subgroups of stimulant users.