Chems4EU: chemsex use and its impacts across four European countries in HIV‐positive men who have sex with men attending HIV services

Whitlock, Gary; Protopapas, Konstantinos; Bernardino, José I; Imaz, Arkaitz; Curran, Adrían; Stingone, Christof; Shivasankar, Sivapatham; Edwards, Sarah; Herbert, Sophie; Thomas, Konstantinos; Micán, Rafael; Prieto, Paula; García, Jorge Néstor; Andreoni, Massimo; Hill, Samantha V.; Okhai, Hajra; Stuart, David; Bourne, Adam; Conway, Katie

doi:10.1111/hiv.13160

Cited by 35 publications

(34 citation statements)

References 16 publications

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“…In our study population, 14% of participants had detectable VL, a rate comparable to a recent study on chemsex use and its impacts across European countries [ 39 ]. Detectable VL in PLWH who engaged in chemsex may be related to suboptimal ART adherence, for which clinical assessment is of particular importance.…”

Section: Discussionsupporting

confidence: 82%

Do ART and Chemsex Drugs Get Along? Potential Drug–Drug Interactions in a Cohort of People Living with HIV Who Engaged in Chemsex: A Retrospective Observational Study

et al. 2022

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Introduction People living with HIV (PLWH) who engaged in chemsex are at risk of potential drug–drug interactions (pDDIs) with recreational drugs. This study aimed to characterize pDDIs between antiretroviral treatment (ART) and chemsex drugs and evaluate their association with unscheduled relevant hospital consultations. Methods We conducted a single-center, retrospective, observational study in a series of gay, bisexual, and other men who have sex with men (gbMSM) living with HIV who engaged in chemsex and who attended a tertiary hospital in Barcelona, Spain, from February 2018 through August 2019. Associations between all recorded pDDIs and relevant unscheduled consultations were estimated using the incidence rate (IR) per 100 person-years of those events compared between patients with no pDDI (green flag) or moderate severity pDDI (orange flag) with patients with high severity pDDI (red flag) using the incidence rate ratio (IRR). Results Among 172 PLWH engaged in chemsex, 249 ART regimens were prescribed: 44% based on integrase inhibitors, 30% on boosted ART, and 26% based on non-nucleoside reverse transcriptase inhibitors. The substances and recreational drugs most frequently used were erectile dysfunction agents (83%), methamphetamine (79%), GHB (77%), and alkyl nitrites (71%). Polydrug use was reported in 52%. We observed 2048 pDDIs. Of these, 23% were orange flag pDDIs; 88% related to boosted ARTs. The IR of the 285 unscheduled relevant episodes in patients with orange flag pDDIs was 64.67 (95% CI 40.07–89.28). The IRR of green flag pDDIs was 1.05 (95% CI 0.60–1.8; p = 0.876). Conclusion One in four pDDIs were of moderate severity but no significant increase in the incidence of unscheduled relevant consultations was observed. A high number of unscheduled consultations, predominantly for psychiatric events and intoxication, were observed. Beyond using non-boosted ART to minimize pDDIs, other factors related to the practice of chemsex must be addressed, in order to offer a better approach. Supplementary Information The online version contains supplementary material available at 10.1007/s40121-022-00694-w.

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Section: Discussionsupporting

confidence: 82%

Do ART and Chemsex Drugs Get Along? Potential Drug–Drug Interactions in a Cohort of People Living with HIV Who Engaged in Chemsex: A Retrospective Observational Study

et al. 2022

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“…A recent report from nine European HIV centres (chems4EU) reported higher rates of recreational drug use including chemsex than we have found. This study also demonstrated the significant harms associated with chemsex, including unwanted impact on psychological well‐being and social lives of individuals affected [1]. However, the chems4EU study did not review any drug–drug interactions between chemsex drugs and antiretroviral therapy.…”

Section: Discussionmentioning

confidence: 87%

“…Furthermore, 38% of the chemsex users who used crystal methamphetamine and/or GHB/GBL were prescribed either cobicistat or ritonavir, leading to potentially harmful drug–drug interactions. Patients who use chemsex drugs may be more likely to have poor antiretroviral adherence; however, 90% of our patients who reported chemsex had an undetectable HIV viral load [1]. During the period of the study, four patients in our patient cohort died from accidental drug overdoses; in one case death was caused by fatal levels of GHB/GBL in the presence of cobicistat.…”

Section: Discussionmentioning

confidence: 99%

“…Chemsex is sexualized drug use, using any of the following specific drugs (chems) to facilitate or enhance sex: particularly crystal methamphetamine, mephedrone and gamma-hydroxybutyrate (GHB)/gamma-butyrolactone (GBL) [1][2][3]. Chemsex is often facilitated via the use of smartphone geospatial networking applications (apps), may last several days and involve multiple sexual partners engaging in condomless anal sex [4,5].…”

Section: Introductionmentioning

confidence: 99%

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Chemsex and antiretroviral prescribing in an HIV cohort in Brighton, UK

et al. 2022

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Objectives: Chemsex has been reported among men who have sex with men (MSM) living with HIV. There have been concerns about potentially harmful drug-drug interactions between chemsex drugs and antiretroviral therapy (ritonavir and cobicistat). We aimed to describe the prevalence and patterns of chemsex users in our HIV clinic population and to evaluate antiretroviral prescribing among chemsex users. Methods:We undertook a cross-sectional study of patients attending our HIV clinic between January 2019 and December 2020. We collected data on patients who disclosed recent recreational drug use including chemsex in the previous 3 months.Results: In all, 2202/2501 (88%) patients were asked about recreational drug use and 514 (23%) disclosed recreational drug use. Eighty-two (4%) of these disclosed recent chemsex; 73 (89%) used crystal methamphetamine, 51 (62%) used gammahydroxybutyrate (GHB)/gamma-butyrolactone (GBL), 55 (67%) reported polydrug use and 63 (76%) reported injecting drug use. The chemsex users were all cis-male MSM and were significantly older (53 vs. 46 years, p < 0.0001), and more likely to have had previous syphilis (73% vs. 28%, p < 0.0001) than patients reporting non-chemsex drug use. All chemsex users were prescribed antiretrovirals and 74 (90%) had an undetectable HIV viral load; 31 (38%) patients were taking either ritonavir (N = 12) or cobicistat (N = 19) as part of their antiretroviral regimen and this was similar to other patients attending for HIV care [31/82 (38%) vs. 768/2419 (31%), p = 0.25]. Conclusions:The prevalence of chemsex users among our HIV clinic attendants is 4%, and 38% of these were prescribed either ritonavir or cobicistat. Chemsex use should be a factor in antiretroviral therapy decision-making to avoid potential harm.

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“…In our cohort, methamphetamine consumption was almost double that in other groups [ 22 , 25 ]. A more comprehensive and multidisciplinary approach to chemsex could avoid considerable individual and public health issues beyond HIV transmission [ 45 , 46 ].…”

Section: Discussionmentioning

confidence: 99%

Evolution of Risk Behaviors, Sexually Transmitted Infections and PrEP Care Continuum in a Hospital-Based PrEP Program in Barcelona, Spain: A Descriptive Study of the First 2 Years’ Experience

et al. 2022

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Introduction Pre-exposure prophylaxis (PrEP) is effective for HIV prevention, but the PrEP care continuum also involves improving PrEP awareness, uptake, adherence, and retention in care. Users’ awareness is often compromised because of vulnerability factors and risk behaviors, such as chemsex practice or specific substance use, which could lead to risk compensation. Correct adherence and retention in care are essential to achieve the full effectiveness of PrEP. This study describes changes in users’ risk behaviors and sexually transmitted infections (STIs), as well also PrEP care continuum details. Methods This was a descriptive single-center retrospective study including adults at high HIV risk screened between November 2019 and June 2021 in the PrEP program of our hospital. Demographic, behavioral, STI, adherence, and retention in care variables were assessed. Data were collected from medical records and self-report questionnaires. Results A total of 295 people were included, 94% men and 5% transgender women, with a mean age of 34 years (SD 10) and 10% sex workers. At baseline, 55% disclosed chemsex practice and 3% slamming. During follow-up, condom use for anal intercourse decreased from 41% to 13% ( p ≤ 0.0001) and one HIV infection was detected; other risk behaviors and STIs remained stable. Chemsex, group sex, fluid exchange, and condomless anal intercourse were related to STI risk. Adherence was correct in 80% of users, and retention in care was 57%. Discontinuations and loss to follow-up were high, mainly affecting transgender women, sex workers, and people practicing fisting. Conclusion PrEP program implementation in our hospital was adequate, since it allowed, in a population at high HIV risk, overall users’ risk behaviors and STIs to remain stable, with only one HIV diagnosis during the follow-up. We should target specific strategies to improve adherence and retention in care, as vulnerable subgroups at higher risk of loss to follow-up are identified.

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Chems4EU: chemsex use and its impacts across four European countries in HIV‐positive men who have sex with men attending HIV services

Cited by 35 publications

References 16 publications

Do ART and Chemsex Drugs Get Along? Potential Drug–Drug Interactions in a Cohort of People Living with HIV Who Engaged in Chemsex: A Retrospective Observational Study

Do ART and Chemsex Drugs Get Along? Potential Drug–Drug Interactions in a Cohort of People Living with HIV Who Engaged in Chemsex: A Retrospective Observational Study

Chemsex and antiretroviral prescribing in an HIV cohort in Brighton, UK

Evolution of Risk Behaviors, Sexually Transmitted Infections and PrEP Care Continuum in a Hospital-Based PrEP Program in Barcelona, Spain: A Descriptive Study of the First 2 Years’ Experience

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