Amphetamine and Methamphetamine Abuse Among HIV Positive Patients

Amphetamine and Methamphetamine Abuse Among HIV Positive Patients

I assisted in some behavioral neuroscience research a few years back utilizing HIV transgenic rats and ended up writing a paper on HIV and Amphetamine/Methamphetamine abuse for my abnormal psychology class as a result.  Here it is, let me know what you think in the comments!
         This paper will discuss some of the behaviors, habits, and effects of amphetamine abuse in HIV positive patients Amphetamines, particularly its derivative Methamphetamine (METH), have been an increasing social issue throughout the recent decades.  The Drug Abuse Warning Network(DAWN) reported that between 1995 and 2002 emergency department visits associated with METH abuse rose 50%(NIDA, 2006).  According to a study examining the self reported risk behavior among amphetamine injectors at U.S. syringe exchange programs there is a higher instance of syringe sharing in amphetamine injectors than other drug abuse patients.  (Braine, 2005) The New York City Department of Health and Mental Hygiene stated that METH poses a particular risk to men who have sex with men because this combination can contribute to behaviors that greatly increase the chance of HIV transmission/contraction (NYC Health 2004) .  Further, according to a report in 2006 by the National Institute on Drug Abuse(NIDA) some of the consequences of METH abuse include increased rates of HIV, Hepatitis B and C transmission. This effect is found not only in individuals who inject METH.  Noninjecting METH abusers are also found to be at an increased risk of transmission of these diseases.(NIDA 2006).  Another study looking at METH use and HIV risk behaviors before and after either incarceration or substance abuse treatment found that these risk behaviors continue to persist after either treatment or incarceration (Cartier , Greenwell, Prendergast 2008).  This paper will attempt to explain the  relationship between  HIV infection and METH abuse as well as address possible treatments and future research directions.
In a paper published in the Drug and Alcohol Review in May of 2008 by Jane Carlisle Maxwell and Beth A. Rutkowski the authors state that use of METH appears to have a stronger relationship to production and supply than other drugs of abuse and that abuse is more prevalent in Western parts of the country and is slowly creeping eastward(MAXWELL, & RUTKOWSKI, 2008).  This trend is also reported in NIDA’s 2006 research report on Methamphetamine Abuse and Addiction(NIDA, 2006). 

When examining issues such as drug abuse it is important to remember that more often than not there is no single factor that causes one to abuse drugs.  More likely, there are many factors when considered all together produce an increased risk and susceptibility to substance abuse (Huba, Melchior, Trevithick, Tierney, & Hodgins, 2000) Huba et al. found that among youth involved inHIV/AIDS service demonstration projects those who were positive for HIV infection were more likely to have issues with substance abuse. Substance abuse fosters physiological changes that may favor HIV transmission(NIDA, 2005). 

It has been well established that HIV infection carries with it risk of developing HIV related central nervous system diseases as well as numerous HIV-associated neurocognitive impairments(Cysique, Maruff, Darby, & Brew, 2006). Among these impairments there appear to be significant deficits to prospective memory.  Prospective memory is often said to be the act of remembering to remember, or at the appropriate time, retrieving a previously encoded memory of future intentions (CAREY, WOODS, RIPPETH, HEATON, & GRANT, 2006). Damage to prospective memory can play a tremendous role in day to day living in today’s world.  In fact, Georgia State University has received a grant to study the evolutionary foundations of prospective memory by comparing differences between “animals” and humans in regards to prospective memory tasks (Craig, 2009). 

In a 2009 paper examining prospective memory in former users of methamphetamine it was found that methamphetamine users suffer from generalized issues with prospective memory and that this effect appears to be strong enough to impact day to day functioning.Further a methamphetamine derivative, MDMA(Ecstasy) has also been associated with impairment of cognitive functioning, including prospective memory(Rendell, Mazur, & Henry, 2009). 

Why is prospective memory impairment particularly important in the context of patients with HIV?  As Contardo et al. reports in the Archives of Clinical Neuropsychology there is an important relationship between prospective memory and antiretroviral adherence.  This study reports that scores on the memory for intentions screening test (MIST), a measure of prospective memory, are correlated with adherence to prescribed medication.  Adherence to prescribed medication schedules, particularly with highly active antiretroviral therapy (HAART), is extremely important for their success(Fisher, Fisher, Amico, & Harman, 2006). 

HAART has had impressive results since its implementation, within 2 years there was a 60-80% reduction in mortality associated with HIV as well as reductions in rates of AIDs and general hospitalizations associated with HIV complications.One of the major concerns regarding HAART Treatments is virologic failure. Viral load measurements are generally taken every 3 months, virologic failure occurs when two consecutive load counts are greater than 500c/ml.  According to the Antiretroviral Therapy chapter in the HIV/AIDS primary care guide virologic failure can occur for 2 reasons (Bartlett, 2004).  The virus can develop resistance to one or more of the regimen or the drugs may be failing to reach the virus for one of many reasons, one of which is lack of adherence to a drug schedule.  However, it has also been found that adherence is an important contributor to virus’ developing resistances to drugs making this single problem influential in both explanations for the failure of this treatment in some cases.  Due to the nature of HAART treatments the development of 1 or possibly 2 resistant strains within a particular patient is not a tremendous issue.  As long as the drug that is no longer having an effect can be identified it can be substituted out for another to offset the effects of resistance(Bartlett, 2004).   The problem, however, is when a patient continually develops resistance to drugs within the HAART regimen.   When this occurs a patient may exhaust their treatment options much faster than would normally occur and this will negatively impact the patient’s prognosis(Fisher, Fisher, Amico, & Harman, 2006). 

Over the past couple of decades evidence for the effects of stress negatively impacting the immune system has been building. This effect appears to grow in intensity as a person ages(Keicolt-Glaser , & Glaser, 2001). Patients with late stage HIV who are older risk a feedback loop where stress from the disease, possibly from repeated drug resistances may further suppress the immune system compounding the problems even more.  Stress has been found to be strongly and regularly associated with substance abuse as well. 

This all, when taken together, is an important reason why those who are HIV positive and also suffer drug abuse related issues must receive treatment for the drug abuse at the very least during but preferably prior to any attempts at HAART treatment.  Further, treatments that improve prospective memory should be considered, even for non drug abusing patients.  This should help reduce problems with drug adherence and in turn help to improve the effectiveness of HAART treatments across the board. 

Aside from the common reasons for seeking treatment for drug abuse HIV patients have other, sometimes very serious, reasons.  Already being immuno compromised the increased risk of contracting other diseases such as hepatitis B and hepatitis C is less than desirable. NIDA reports to congress that methamphetamine abuse can affect the progression of HIV including increased HIV viral loads in the brain.  Further, it appears that HIV patients undergoing HAART treatment are at a greater risk of developing AIDSagain potentially due to adherence issues.  Some early studies have shown that there might be some interactions going on between HIV and METH that could be exacerbating the problem but further research is needed to say for sure(NIDA, 2005). 

In NIDA’s report to congress they reference cognitive behavioral therapies as possible treatments. One such treatment, The Matrix Model, was developed decades ago as a treatment for cocaine abuse.  When this method is utilized with METH abusers it has been found to be a successful treatment. Further,Motivational Incentives for Enhanced Drug Abuse Recovery (MIEDAR), another cocaine and methamphetamine CBT therapy has been demonstrated to be effective in abstaining from methamphetamine abuse(NIDA, 2005). 

Drug therapies are also in the works for METH treatment and there are a number of drugs currently being evaluated as potential treatments.  These drugs include but are not limited to Bupropion, Sertraline, Lobeline, Aripirazole, Carvediol, Clonidine, Atomoxetine, Prazosin, Modafinil, Perindopril, Rivastigmine, Topiramate, and Baclofen. However, none of these medications directly treat METH abuse and behavioral therapies are currently the most promising treatments(NIDA, 2005) 

As we can see throughout this paper the issues of methamphetamine abuse and HIV transmission are closely related.  There appears to be a synergistic effect going on between all of the factors involved including those from long before substance abuse or HIV contraction. This cycle appears to be something like the following.  Stress and other risk factors increase ones risk of substance abuse as well as suppress immune function.  Substance abuse can in turn increase risk of contracting HIV. If HIV is contracted this then can increase the likelihood of drug abuse and can further increase stress levels. The combination of HIV and METH abuse can then negatively impact memory functioning which in turn can negatively impact the performance of HIV treatments further adding to stress which can continue to negatively impact immune resistances, resistance to drug abuse, and overall wellbeing. 

            When administering treatment to HIV patients in general and specifically HIV patients that abuse METH it is important to consider all of the variables that may negatively impact treatment and further reduce quality or time of life.  HIV patients should be considered at high risk of drug abuse and should be made aware that beginning or continued drug abuse will negatively impact how long they will be able to survive with HIV/AIDS as well as how they will experience that time.  Participating in drug abuse will decrease both cognitive function as well as health, and evidence indicates this effect will be much greater within this population than in the general public. 

References 

Bartlett, J.G. (Ed.). (2004). A Guide to primary care of people with hiv/aids. Rockville, MD: Department of Health and Human Services Health Resources and Services Administration HIV/AIDS Bureau. 

Braine, N., Jarlais, D.C.D, Goldblatt, C., Zadoretzky, C., Tuner, C. (2005). HIV Risk Behavior Among Amphetamine Injectors At U.S. Syringe Exchange Programs. AIDS Education and Prevention, 17(6), 515–524. 

Cartier, J., Greenwell, L. Prendergast, M.L. (2008). The Persistence of HIV Risk Behaviors Among Methamphetamine-Using Offenders. Journal of Psychoactive Drugs; 40(4), pg. 437 

CAREY, C.L., WOODS, S.P., RIPPETH, J.D., HEATON, R.K., & GRANT, I. (2006). February 2006: pp. 0–0 prospective memory in hiv-1 infection. Journal of Clinical and Experimental Neuropsychology,, 28, 536–548,. 

Craig, J. (2009, October 22). GSU scientists receive grant to study prospective memory. Retrieved from http://www.gsu.edu/39064.html 

Cysique, L.A.J., Maruff, P., Darby, D., & Brew, B.J. (2006). The Assessment of cognitive function in advanced hiv-1 infection and aids dementia complex using a new computerised cognitive test battery. Archives of Clinical Neuropsychology, 21, 185–194. 

Huba, G.J., Melchior, L.A., Trevithick, L., Tierney, S., & Hodgins, A. (2000). Predicting substance abuse among youth with, or at high risk for, hiv. Psychology of Addictive Behaviors, 14(2), 197-205. 

Keicolt-Glaser , J.K., & Glaser, Ronld. (2001). Stress and immunity:age enhances the risks. Current Directions in Psychological Science, 10(1), 18-21. 

MAXWELL, J.C., & RUTKOWSKI, B.A. (2008). The Prevalence of methamphetamine and amphetamine abuse in North America: a review of the indicators, 1992 – 2007. Drug and Alcohol Review, 27, 229 – 235. 

NIDA, Initials. (2005). Medications development research for treatment of amphetamine and methamphetamine addiction. Report to Congress

National Institute on Drug Abuse(NIDA) (2006). Methamphetamine abuse and addiction. NIH Publication Number 06-4210 

New York City Department of Health and Mental Hygiene (2004). Methamphetamine and HIV. Health Bulletin #16 

Rendell, P.G., Mazur, M., & Henry, J.D. (2009). Prospective memory impairment in former users of methamphetamine. Psychopharmacology, 203, 609–616. 

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