Overamped: Stimulant Use and HIV Pathogenesis

• Published in: Current HIV/AIDS reports Vol. 20; no. 6; pp. 321 - 332
• Main Authors: Ross, Emily J., Williams, Renessa S., Viamonte, Michael, Reynolds, John M., Duncan, Dustin T., Paul, Robert H., Carrico, Adam W.
• Format: Journal Article
• Language: English
• Published: New York Springer US 01-12-2023; Springer Nature B.V
• Subjects: Acquired Immunodeficiency Syndrome - drug therapy; Biomarkers; Cell-mediated immunity; Central Nervous System Stimulants - adverse effects; Cocaine; Crack Cocaine - adverse effects; HIV; HIV Infections - pathology; Human immunodeficiency virus; Humans; Medicine; Medicine & Public Health; Methamphetamine; Methamphetamine - adverse effects; Microbiomes; Pathogenesis; Stimulants; Topical Collection on Behavioral-Bio-Medical Interface; Adherence; Cocaine; Immune activation; Inflammation; HIV; Methamphetamine
• ISSN: 1548-3568; 1548-3576
• DOI: 10.1007/s11904-023-00672-y

Purpose of Review
In the era of HIV treatment as prevention (TasP), more clarity is needed regarding whether people with HIV who use stimulants (i.e., methamphetamine, powder cocaine, and crack cocaine) display elevated HIV viral load and greater immune dysregulation.
Recent Findings
Although rates of viral suppression have improved in the TasP era, stimulant use was independently associated with elevated viral load in 23 of 28 studies included in our review. In the 12 studies examining other HIV disease markers, there was preliminary evidence for stimulant-associated alterations in gut-immune dysfunction and cellular immunity despite effective HIV treatment. Studies generally focused on documenting the direct associations of stimulant use with biomarkers of HIV pathogenesis without placing these in the context of social determinants of health.
Summary
Stimulant use is a key barrier to optimizing the effectiveness of TasP. Elucidating the microbiome-gut-brain axis pathways whereby stimulants alter neuroimmune functioning could identify viable targets for pharmacotherapies for stimulant use disorders. Examining interpersonal, neighborhood, and structural determinants that could modify the associations of stimulant use with biomarkers of HIV pathogenesis is critical to guiding the development of comprehensive, multi-level interventions.