Stimulant Use Exacerbates HIV for Virally Suppressed Patients

Adam Carrico, PhD, associate professor of Public Health Sciences and Psychology at the University of Miami Miller School of Medicine

Adam Carrico, PhD

New research looking at the interplay between HIV and the use of stimulants shows that the drugs can have significant negative impacts on the health of those whose viral load is controlled by antiretroviral therapy (ART).

Researchers looked at epigenetic samples of 55 men who were both HIV-positive and users of methamphetamines. The analysis showed a differential expression of 32 genes and perturbation of 168 pathways in patients who had recently used the drugs. Some of those genes are associated with the HIV immune reservoir, immune activation, and inflammation, according to study co-author Adam Carrico, PhD, associate professor of Public Health Sciences and Psychology at the University of Miami Miller School of Medicine.

All of the men in the study were on effective ART. Carrico said those data suggest stimulants could be causing the virus to become more active and could expand the HIV reservoirs of patients. The reservoirs essentially serve as hiding spots for the vaccine, escaping the reach of ART.

One implication of the study, Carrico said, is that the stimulant research could lead to the development of methods to “coax” the virus out of those hiding places so that it could be attacked by the ART medications.

“One of the dominant theories in HIV cure research is ‘wake and kill,’” Carrico told MD Magazine. “This study could help us to understand those mechanisms that regulate the ability of HIV to hide in immune cells.”

In the meantime, Carrico, a clinical psychologist, is also working on a study looking at behavioral interventions that could reduce stimulant use among people living with HIV. In his research, he has probed a range of effects of stimulant use on HIV patients and on the virus itself.

“It is often the case that these patients experience difficulties when managing their HIV,” he said. “But I began to wonder if there are direct effects of methamphetamine use on the immune system even when we can get patients to be virally suppressed.”

In a separate study of 84 HIV-positive patients who achieved suppression and who used stimulants, Carrico and colleagues found that when patients recently used stimulants, they had higher levels of soluble CD14 (sCD14). Increased levels of sCD14 have been correlated to faster progression of HIV and to cardiovascular disease.

The 2 studies focus specifically on patients who are taking ART, and thus the available data does not explain what might be happening to patients who are not on ART but do take stimulants. From a healthcare perspective, though, Carrico said the advice to such patients is straightforward.

“I would say the best thing that stimulant users who are not on ART could do would be the start ART and address the barriers that their stimulant use can create to achieving sustained viral suppression,” he said. “This would be the best way to improve health outcomes among those who are not currently on ART.”

Carrico’s most recent paper, titled “Recent stimulant use and leukocyte gene expression in methamphetamine users with treated HIV infection,” was published last month in Brain, Behavior, and Immunity. His earlier study, on sCD14, was published in March in the journal AIDS.