Recreational drug use among individuals living with HIV in Europe: review of the prevalence, comparison with the general population and HIV guidelines recommendations

Abstract

Background: Adherence problems, interactions and higher rate of risk activities have been observed in HIV individuals using recreational drugs. Our aim was to describe recreational drug use in both HIV individuals and general population in Europe, and to assess at what extent HIV guidelines address this issue.Methods: Data on recreational drug use across Europe were obtained from the European Monitoring Centre for Drugs and Drug Addiction for the general population, and through Pubmed search. for HIV patients. We assessed the incorporation of recreational drug issues in HIV treatment guidelines for the following topics: (a) recreational drugs; (b) adherence to antiretrovirals; (c) interactions; (d) transmission risk. Guidelines included: World Health Organization; European Aids Clinical Society; U.S. Department of Health and Human Services; International Antiviral Society-USA; and seven European national guidelines.Results: 29 countries reported recreational drug use in general population. The highest prevalences were observed for Cannabis (i.e., 8–10% in Spain, France, and Czech Republic) followed by cocaine, amphetamines and ecstasy. The 13 studies selected in the systematic review showed a great variability in recreational drug use on the HIV population. Apart from classical recreational drugs, we found a relevant use of new drugs including sexual experience enhancers. Polydrug consumption was about 50% in some studies. Most guidelines included general information about recreational drugs, showing great variability on the inclusion of the evaluated topics. We found more specific, evidence-based recommendations on interactions, followed by medication adherence and transmission risk.Conclusions: Available data on the people living with HIV suggest a higher use of recreational drugs than in the general population, which is already relevant. However, recreational drug issues should be included or addressed more thoroughly in most guidelines.

High-intensity cannabis use and HIV clinical outcomes among HIV-positive people who use illicit drugs in Vancouver, Canada

“…This proportion is approximately twice as high as previously recorded in general samples of people living with HIV/AIDS in other North American (de Jong et al, 2005; Prentiss et al, 2004; Rosen et al, 2013) and European (Garin et al, 2015) jurisdictions, where prevalence of any cannabis more closely approximates our presently recorded median 20% prevalence of daily use. However, our estimates closely resemble those recorded in a French cohort of patients co-infected with HIV and HCV (Marcellin et al, 2016).…”

Prevalence and clinical impact of recreational drug consumption in people living with HIV on treatment: a cross-sectional study

“…9 Unlike the case of injecting drug users, with clear evidence of poor HIV-related outcomes and specific recommendations,10 interest in recreational drugs is recent in the HIV field. A previous, systematic review found 12 articles reporting prevalence data on recreational drug use in PLWHIV in Europe 11. Relevant use of recreational drugs was found in these studies.…”

“…Despite the potential clinical impact of recreational drug issues, guidelines on HIV antiretroviral therapy have poorly incorporated these elements 11. Guidelines tend to include general claims but usually lack specific recommendations.…”

“…Guidelines tend to include general claims but usually lack specific recommendations. This could be explained as many of the efforts in this field have focused on studying the association between recreational drug use and the risk of being infected with HIV11 18 19 rather than assessing the impact of recreational drugs on people already living with HIV. Clinicians, researchers and policymakers may not be fully aware of the real magnitude of the problem since both the prevalence and the clinical impact of recreational drug use on PLWHIV is unclear, especially referring to those people on treatment.…”

Recreational drug use and chemsex among HIV‐infected in‐patients: a unique screening opportunity

“…Data reveal higher rates of lifetime RDU relative to the general population among sexual health clinic attendees [6,11] and HIV-positive MSM attending out-patient clinics [1,3]. However, there is a distinct lack of data regarding RDU among the HIV-infected in-patient population.…”