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

Abstract

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.

Toxic-Induced Encephalopathy Following Chemsex in a Young HIV-Positive Male: A Complex Case of Acute Cognitive Impairment with Anterograde Amnesia and Behavioral Alterations

“…In a study of 172 HIV-positive chemsex participants, 30% used boosted ART. Of 2048 identified potential drug–drug interactions, 23% were deemed concerning, with 88% due to boosted ART [ 34 ]. Therefore, for the HIV chemsex community, it is crucial to consider non-boosted ART as a safer alternative to minimize potential drug interactions.…”

Drug behaviors, sexually transmitted infection prevention, and sexual consent during chemsex: insights generated in the Budd app after each chemsex session

“…In other European countries, methamphetamine (Spain), GHB/GBL (Norway, Spain, The Netherlands), and cocaine (Norway, France and Italy) were reported as frequently used drugs in a sexual context ( 16–18 ). Polydrug use is also very prevalent in our study: all participants reported the use of more than one substance, during 95% of all events.…”

Clinical Relevance of Drug Interactions in People Living with Human Immunodeficiency Virus on Antiretroviral Therapy - Update 2022: Systematic Review

“…Drug substance misuse is an important consideration in PLHIV on ARV therapy, requiring an integrated approach based on evidence [2]. Therefore, there are clinically relevant drug interactions associated with drug substance misuse, such as ketamine, amphetamine, and substitutes (methamphetamine, methylenedioxymethamphetamine-MDMA; 'ecstasy') with RTV-boosted PIs [14,[75][76][77][78][79][80] and EVG/COBI [14,15,75,76,80,142,143], increasing the risk of toxicity, including a possible fatal serotonergic reaction. Furthermore, clinically relevant interactions were identified between psychotropic drugs, particularly benzodiazepines, which have the potential to cause dependence in patients.…”