Recreational drugs and HIV in Europe: current use of recreational drugs and principal HIV guidelines related recommendations

Abstract

IntroductionRecreational drug consumption has been associated with both higher rates of risk activities related to HIV transmission and also worse adherence and management of HIV patients under HAART treatment. Moreover, relevant interactions may be present in patients under HAART treatment. Our aim is to present the European trends of drug consumption per country and age groups and assess the way drug consumption is addressed in general HIV guidelines.Materials and MethodsLast 12-month prevalence drug use was obtained from the European Monitoring Centre for Drugs and Drug Addiction for the four most consumed drugs (cannabis, cocaine, amphetamines, ecstasys). Consumption rates were collected and analyzed by country and age. Principal HIV guidelines were assessed to identify the degree of incorporation of drug use issues at three levels: transmission risk, adherence to the HAART and management of interactions. Guidelines: (a) WHO; (b) EACS; (c) BHIVA; (d) US DHHS; (e) IAS-USA; (f) GESIDA; (g) French CPG; (h) Italian CPG.ResultsData on drugs of abuse consumption was obtained from 29 European countries, with results showing relevant drug utilization in Europe. Cannabis was the most frequent drug across all countries, with 10 countries over 5% of prevalence over the last year. Other drugs prevalence accounted for about 0.5–1%, reaching up to: 2.1% for cocaine in Spain, 1.4% for ecstasy in the Netherlands and 1.1% for amphetamines in Estonia. 15–24 and 25–34 years old subgroups had the highest prevalence, although notable use of cannabis and cocaine was also found in the 35–44 and 45–54 subgroups. From the eight guidelines assessed, six considered recreational drugs at any point. Recommendations for specific drugs were given in 50% of the guidelines. From those guidelines addressing drug consumption: three assessed risk habits which related to transmission risk, six appraised issues on adherence to HAART and five comprised data on interactions between recreational drugs and HAART. Additionally, five guidelines mentioned drugs in the context of other issues, such as sexual dysfunction or HIV-associated neurocognitive impairment.ConclusionsUse of recreational drugs is frequent in Europe, not only in the younger population but also in other unexpected older subgroups. The scarce information found in the guidelines has a potential implication for patients and clinicians; therefore, there is a need to include specific recommendations about the clinical management of people living with HIV who use recreational drugs.

Clinical outcomes of patients infected with HIV through use of injected drugs compared to patients infected through sexual transmission: late presentation, delayed anti‐retroviral treatment and higher mortality

“…This study shows that although the proportion of HIV‐IDU among all HIV‐infected patients is declining, they merit special attention due to late presentation, late initiation of treatment and higher mortality and risk of AIDS. Although specific strategies targeting these patients are needed to improve their clinical care, recommendations aimed specifically at PWID are extremely scarce in HIV clinical practice guidelines . Several strategies have been shown to improve adherence and response to ART in HIV‐IDU, such as methadone substitution programmes, access to multi‐disciplinary support centres and directly observed therapy .…”

Cocaine dependence does not contribute substantially to white matter abnormalities in HIV infection

“…An important comorbidity is the abuse of stimulant drugs such as cocaine, which is disproportionately prevalent among HIV-infected persons in high-income countries (Bing et al , 2001; Garin Escriva et al , 2014; Mimiaga et al , 2013; Pence et al , 2008; Siconolfi et al , 2013). In a recent study of >3,000 patients receiving HIV care in four American cities, 8.5% reported crack-cocaine use in the past 3 months (Mimiaga et al , 2013).…”

Independent effects of HIV infection and cocaine dependence on neurocognitive impairment in a community sample living in the southern United States

“…Drug abuse, particularly the use of stimulants such as cocaine and methamphetamine, is disproportionately prevalent in HIV-infected persons (Bing et al, 2001; Garin Escriva et al, 2014; Mimiaga et al, 2013; Pence et al, 2008; Siconolfi et al, 2013). In a recent study of >3,000 patients receiving HIV care in four United States (US) cities, 9.0% used amphetamines and 8.5% used crack-cocaine in the past 3 months (Mimiaga et al, 2013).…”