How Is Meth Use Linked To Faster Progression Of HIV?

A recent study from the University of California, San Diego (UCSD) found that men infected with HIV who use methamphetamine may experience faster T-cell activation and proliferation. In other words, the use of methamphetamine may cause HIV to progress more rapidly to AIDS.

Who Was Studied?

The study looked at 50 men who have sex with men (MSM). The average age of the participants was 46, and each had been on retroviral medication for HIV for an average of four years. Forty-two percent of the participants were white, 20 percent were black and 4 percent were Hispanic.

Once a month for a year, the study participants completed a survey about their adherence to antiretroviral treatment and their use of various party drugs. Twenty of the men reported using marijuana during the study period, 16 used meth, 12 reported drinking alcohol, 11 used cocaine and 13 of the respondents used some other party drug.

The researchers also used frozen samples of a type of blood cell with a round nucleus known as peripheral blood mononuclear cells (PBMCs) to evaluate reservoirs of HIV DNA, cellular HIV RNA, and the activation and proliferation of immune cells named CD4 and CD8 (sometimes known as T-helper cells or T cells). HIV binds itself to CD4 cells, which multiply in order to help combat infection. In this way, the immune system actually makes more copies of the virus it is trying to destroy.

What The UCSD Study Found

The UCSD study found that the men who used meth had higher levels of activated and proliferating CD8 and CD8 cells, poorer CD4/CD8 ratios, and greater reservoirs of HIV DNA that had been incorporated into the genetic material of a host cell—proviral HIV DNA.

The study also found higher cytomegalovirus (CMV) load and shedding in the semen of meth users. While HIV is a sexually transmitted disease (STD), and sexual activity remains the leading cause of HIV transmission around the world, levels of HIV in the semen of an infected man are actually lower than the levels of HIV in the blood. However, HIV levels in semen are higher in a subgroup of men, and the UCSD study found that HIV levels in semen were more likely to be high in the men who used meth. A higher level of HIV in semen makes it more likely that an infected man could transmit the disease through unprotected intercourse. Previous studies have found that HIV transmission among meth users occurs at a higher rate than among other HIV-positive individuals.

Although the participants in this study reported a variety of recreational drug use, meth was the only drug that appeared to have any significant influence on T-cell activation and proliferation, and on levels of proviral HIV DNA.

In order to eliminate variables that could also explain the difference in the progression of HIV, the researchers selected MSM of a similar age, with similar baseline CD4 and CD8 counts, who had spent a similar amount of time on antiretroviral medications, and who were not infected with any other STDs that could contribute to the worsening of their HIV.

Researchers do not yet understand why the use of methamphetamine could speed the progression from HIV to AIDS or increase cognitive impairment among men with HIV. One possibility is that meth use corresponds with difficulty sticking to a regimen of anti-viral medication (although the men in this study who used meth reported similar rates of adherence as non-meth users). Risky behaviors common to meth users may also have something to do with speeding health deterioration among men with HIV.

However, the fact that the other recreational substances used by men in the study did not affect their HIV makes it somewhat less likely that risky behaviors associated with drug use will successfully explain the way meth affects HIV. It may be that there is some physiological cause and effect through which meth use directly promotes AIDS progression and increased cognitive deterioration.

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