Increasing emergency department admissions for chemsex-related intoxications in Barcelona, Spain, among people living with HIV: an observational study from 2018 to 2020

Abstract

Background Chemsex is a novel phenomenon referring to the use of drugs, including crystal methamphetamine, gammahydroxybutyric acid (GHB)/gamma-butyrolactone (GABA) and mephedrone, to facilitate, enhance, and prolong the sexual experience in men who have sex with men in large cities internationally. There is a growing concern about chemsex and fatal cases among people living with HIV on antiretroviral therapy. This study aimed to describe the clinical characteristics of chemsex-related intoxications. Material and methods An observational study was conducted in people living with HIV who were admitted for chemsex-related intoxications in an emergency department of a teaching hospital in Barcelona, Spain, from 2018 to 2020. Severe acute intoxications were defined according to the Poisoning Severity Score. Results One hundred and fifteen male patients with a median age of 35.6±7 years were included in the study:15 (13.1%) in 2018, 32 (27.8%) in 2019 and 68 (59.1%) in 2020. All patients had stable housing, 107(93.0%) were Spanish citizen and 32 (27.8%) had mental health disorders. Median CD4 lymphocyte count was 624 (500–765) cells/mm3 and 99 (86.1%) had HIV-1 RNA suppression. Poly-drug use was observed in 51(44.3%) cases and methamphetamine in 75(65,2%) and gammahydroxibutiric acid in 68 (59.1%) were the main drugs used. Potential drug interactions due to the inhibition of cytochrome P450 by antiviral therapy was determined in 36 (31.3%) patients. Severe intoxications cases affecting neurologic and respiratory systems were diagnosed in 12 (10.4%) patients and no patient died. CD4 cell counts ≤500 cells (O.R.:4.2; C.I.95%:1.2–14.6) and mental health disorders (O.R.: 2.9; C. I 95%: 0.8–9.9) were associated with severe acute drug intoxications in the bivariate analyses. Conclusions Chemsex-related intoxications are an increasing clinical problem in people living with HIV. Chemsex should be routinely screened and addressed in clinical practice, particularly for people with mental illness and low CD4 cell counts, who are at higher risk for severe intoxications.

Emergency detection of HIV infection in patients consulting for conditions potentially related to occult infection: Initial results of the “Urgències VIHgila” program

“…Numerosos estudios han mostrado la importancia de una buena aproximación a este colectivo en el que, más allá de valorar convenientemente en los SUH el riesgo de la exposición y facilitar la profilaxis, debe realizarse para los pacientes que consultaron por problemas derivados de la práctica de chemsex, que se estimó en un 7,41%. No sorprende, pues, esta es una circunstancia bien conocida de alto riesgo, no solo de positividad al ser consumidores de drogas, sino también de transmisión por las propias condiciones de la práctica de chemsex [16][17][18][19][20]. Aunque esta circunstancia solo se dé en determinadas zonas y ciertos SUH (en nuestro caso, los dos diagnósticos procedían del mismo SUH), los SUH deben estar especialmente vigilantes a ella, pues las consultas de este grupo de pacientes se realizan mayoritariamente en ellos y no en otros puntos de la red asistencial.…”

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

“…To our knowledge, this is the first study to assess pDDIs between chemsex drugs and ART in a sample comprised exclusively of PLWH who engaged in chemsex. A recent study described intoxication caused by potential chemsex-related drugs; however, the results were not evaluated on the basis of pDDIs as in the present study [ 27 ].…”

“…Potential DDIs were checked using two freely available online software tools: the Liverpool HIV drug interaction database website [ 26 ] and “HIV Interactions” from HCB [ 27 ]. The Liverpool HIV drug interactions database categorized pDDI into four groups, illustrated by colored flags, as follows: green for “no expected interactions”; yellow for “potential weak interaction”; orange for “potential interaction”; and red for “interaction contraindicating its co-administration.” The allocation of each flag is based on available evidence, whose level of quality ranged according to GRADE criteria [ 28 ].…”

“…Data were collected in the electronic medical record system of the HIV Unit and in specific electronic case report form (eCRF) implemented in REDCap hosted at HCB. Potential DDIs were checked using two freely available online software tools: the Liverpool HIV drug interaction database website [26] and ''HIV Interactions'' from HCB [27]. The Liverpool HIV drug interactions database categorized pDDI into four groups, illustrated by colored flags, as follows: green for ''no expected interactions''; yellow for ''potential weak interaction''; orange for ''potential interaction''; and red for ''interaction contraindicating its co-administration.''…”

Role of emergency departments and emergency physicians in expanding clinical knowledge on drug-related events

“…For decades, clinical toxicology has been one of the subspecialties in which emergency physicians can expand their careers in the USA [21]. The close proximity to patients that we emergency physicians have allows us to be the professionals best positioned to learn and understand new toxicological behaviors such as chemsex or chemical submission [22], or to discern the absence of toxic pathology in cases of collective psychosis which has led to the needle-stick epidemic sweeping Europe in 2022 [23]. However, at the same time, this privileged position as watchtowers and stakeholders entails the responsibility of informing and training other health professionals about this exciting field of knowledge that is Toxicology.…”