Crystal methamphetamine use and antiretroviral drug resistance: a pilot study of behavioral and clinical correlates.

he prevalence of recreational crystal methamphetamine use and related emergency room admissions are on the rise across the United States,1,2 accompanied by a curious media sometimes quick to sensationalize the trend, other times to isolate its impact on specific social groups (eg, gay and bisexual men, circuit party attendees).3,4 According to the World Health Organization (WHO), amphetamines are the second most commonly used and abused controlled substances, after cannabis. More than 35 million people regularly abuse these substances.1,5 Even episodic or intermittent use of methamphetamines is associated with risky sexual practices likely to transmit HIV, such as unprotected anal intercourse (UAI) with serodiscordant sex partners.6 To the chagrin of public health scholars, crystal methamphetamine use has exploded concurrently with two other disconcerting trends: first, an increase in new HIV infections, particularly within the gay dance “circuit” and, on average, among an older cohort of gay men (eg, the average age of a newly infected gay man in New York in 2005 is around 40 years)7-13 and second, a rise in antiretroviral (ARV) drug resistance within already-infected individuals.14 Antiretroviral drug resistance is a primary cause of treatment failure, is connected with neurological damage, and is linked to increased mortality.15-20 It therefore behooves researchers interested in treatment efficacy and group health to inquire into the relationship between crystal methamphetamine (ab)use and ARV drug resistance. The crystal methamphetamine use HIV infection-ARV drug resistance nexus is troubling. This is perhaps nowhere more pronounced than for communities of men who have sex with men (MSM), which are already encumbered by the persistence of risky sexual practices, including a resurgence of UAI and other activities associated with HIV transmission.9,21,22 Crystal methamphetamine use is often a culprit during seroconversion. One Los Angeles study found that 61% of gay and bisexual men seeking treatment for crystal methamphetamine dependence were infected with HIV.1 A recent San Francisco study also found that HIV incidence among methamphetamine users was statistically higher than among non-users, with users at least three times as likely as nonusers to be HIV-positive.23 These studies, along with others, suggest that crystal methamphetamine use is a common co-morbidity among HIV-positive individuals, whose viral loads also increase in its presence.14 Crystal methamphetamine-using seropositive individuals are at greater risk for ARV drug resistance, a relationship that is attributable to one or more of three causal mechanisms, of which two are clinical and one is behavioral.