Club Drugs and HIV Infection: A Review

Abstract

Club drug use is common among populations with human immunodeficiency virus (HIV) and populations at high risk for HIV infection. Club drugs have a myriad of acute and chronic medical consequences. Club drug-related visits to the emergency department and admissions for treatment of substance use have increased dramatically over the past 15 years. Most epidemiological data support the role of club drugs in increasing sexual risk behavior, with some studies demonstrating an independent association between use of certain club drugs and HIV infection. The direct influence of club drugs on progression of HIV disease remains to be determined; however, club drugs may interact with certain retroviral medications and have been associated with decreased adherence to medication. Clinicians should ask all patients about patterns of club drug use, counsel patients about the risks associated with club drug use, and refer patients to appropriate behavioral treatment programs for substance use when clinically indicated.Drugs that are frequently used in dance clubs or at circuit parties or rave parties are known collectively as "club drugs" [1]. Because of the frequent use of club drugs among persons who are at risk for HIV infection or are infected with HIV, this review will include 3,4-methylenedioxymethamphetamine (MDMA; also known as "Ecstasy"), methamphetamine, ketamine, g-hydroxybutyrate (GHB), and inhaled nitrites (known as "poppers"). The present article provides a general overview of the epidemiological profile and medical consequences of club drugs and also provides recommendations for clinicians treating patients who use club drugs, emphasizing the implications of club drug use among persons with HIV infection and persons at high risk for HIV infection. OVERVIEW OF CLUB DRUGSUse of club drugs is a public health concern. In 2004, according to the population-based National Survey on Drug Abuse and Health, it was estimated that, in the United States, 1.9 million persons aged у12 years used MDMA and 1.4 million used methamphetamine; in comparison, 1.3 million used crack cocaine and 398,000 used heroin [2]. The burden of club drug use on the health care system is great: the Drug Abuse Warning Network showed that, between 1994 and 2001, emergency department visits associated with MDMA, ketamine, and GHB use increased ∼22-, 35-, and 60-fold, respectively [3].As is the case with substance use in general, club drug use is more prevalent among men who have sex with men (MSM), compared with the general population [4]. A population-based study of urban gay men found that, in the 6 months before being interviewed, 20% of the men reported using poppers, 12% reported using MDMA, and 10% reported using methamphetamines; HIV-infected men were more likely to report use of multiple drugs and frequent drug use [5]. A probabilitybased sample of young men (age range, 15-22 years) from 7 cities in the United States found that, in the 6 months before interviews were conducted, 14% of the men reported using poppers, 19% reported using MDMA, a...

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