Recreational drug use, polydrug use, and sexual behaviour in HIV-diagnosed men who have sex with men in the UK: results from the cross-sectional ASTRA study

Daskalopoulou, Marina; Rodger, Alison; Phillips, Andrew; Sherr, Lorraine; Speakman, Andrew; Collins, Simon; Elford, Jonathan; Johnson, Margaret; Gilson, Richard; Fisher, Martin; Wilkins, Ed; Anderson, Jane; McDonnell, Jeffrey J.; Edwards, Simon; Perry, Nicky; O’Connell, Rebecca; Lascar, Monica; Jones, Martin; Johnson, Anne M; Hart, Graham; Miners, Alec; Geretti, Anna María; Burman, William J.; Lampe, Fiona

doi:10.1016/s2352-3018(14)70001-3

Cited by 269 publications

(303 citation statements)

References 25 publications

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“…This supports anecdotal evidence that GHB/GBL is more commonly used in private rather than public nightlife settings, [27] and is in accord with the use of these drugs in Chemsex. Users in private settings are potentially isolated from advice services and more vulnerable to harm.…”

Section: Discussionsupporting

confidence: 82%

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An observed rise in γ-hydroxybutyrate-associated deaths in London: Evidence to suggest a possible link with concomitant rise in chemsex

Hockenhull

Murphy

Paterson

2017

Forensic Science International

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Section: Discussionsupporting

confidence: 82%

“…[29] It has been suggested the rise in HIV could be linked to a rise in risky behaviour associated with chemsex. [27,30,31] Our findings show that the lower age limit for GHB-associated deaths was higher than for cocaine-or MDMA-associated deaths, and the majority had a history of previous drug use.…”

Section: Discussionmentioning

confidence: 69%

An observed rise in γ-hydroxybutyrate-associated deaths in London: Evidence to suggest a possible link with concomitant rise in chemsex

Hockenhull

Murphy

Paterson

2017

Forensic Science International

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“…Moreover, it appears that although prevalence of self-reported last-year use of crystal meth appears to not have changed (4.5% in this analysis as compared to 4.7% reported in Bonell et al (Daskalopoulou et al, 2014). Our findings on crystal meth use by HIV testing status were also similar, again indicating much higher use among men with diagnosed HIV.…”

Section: Discussionsupporting

confidence: 59%

Predictors of crystal methamphetamine use in a community-based sample of UK men who have sex with men

Melendez‐Torres

Bonell

Hickson

et al. 2016

International Journal of Drug Policy

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Permanent WRAP URL:http://wrap.warwick.ac.uk/81602 Copyright and reuse:The Warwick Research Archive Portal (WRAP) makes this work by researchers of the University of Warwick available open access under the following conditions. Copyright © and all moral rights to the version of the paper presented here belong to the individual author(s) and/or other copyright owners. To the extent reasonable and practicable the material made available in WRAP has been checked for eligibility before being made available.Copies of full items can be used for personal research or study, educational, or not-for-profit purposes without prior permission or charge. Provided that the authors, title and full bibliographic details are credited, a hyperlink and/or URL is given for the original metadata page and the content is not changed in any way.

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“…On the basis of the work undertaken here, a re-evaluation of current diagnostic criteria for NCI in people infected with HIV has been proposed, including an increase in the level of deficit required to meet the criteria. In addition, attention has been drawn to many other difficulties experienced by those living long term with HIV (as shown by the results from the ASTRA study) -including depression, 47 and misuse of drugs and alcohol 31 -that, if addressed, might improve any impairments to cognition.…”

Section: The Antiretrovirals Sexual Transmission Risk and Attitudes mentioning

confidence: 99%

Implications for a policy of initiating antiretroviral therapy in people diagnosed with human immunodeficiency virus: the CAPRA research programme

Miltz

Phillips

Speakman

et al. 2017

Programme Grants Appl Res

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BackgroundMore than 100,000 people in the UK are living with a human immunodeficiency virus (HIV) infection. There are currently estimated to be around 4000 people newly infected in the UK per year, mostly men who have sex with men (MSM). It has become increasingly clear that antiretroviral therapy (ART) used to treat people infected with HIV also has a profound effect on infectivity. At the initiation of the programme, it was the policy in the UK to initiate ART in people when their cluster of differentiation 4 (CD4) count was approaching 350/µl.ObjectivesTo assess what would be the effectiveness and cost-effectiveness of a policy of immediate initiation of ART at diagnosis among MSM, taking into account the potential reductions in new infections.DesignWe calibrated an individual-based model of HIV transmission, progression and the effect of ART in MSM, informed by a series of studies on sexual behaviour in relation to ART use and the transmission risk in people with viral suppression on ART, and by surveillance data collected by Public Health England.Setting, participants and interventionsThe series of studies used to inform the model included (1) the Antiretrovirals, Sexual Transmission Risk and Attitudes (ASTRA) study, a cross-sectional self-administered questionnaire study of people diagnosed with HIV attending eight HIV outpatient clinics in the UK (2011–12); (2) the Cognitive Impairment in People with HIV in the European Region (CIPHER) study, a study of levels of neurocognitive impairment in HIV-positive ASTRA participants and people from HIV clinics in Rome, Copenhagen and Minsk; (3) the Attitudes to, and Understanding of, Risk of Acquisition of HIV (AURAH) study, a cross-sectional self-administered questionnaire study of individuals who have not been diagnosed as HIV-positive attending 20 genitourinary medicine clinics across the UK (2013–14); (4) a substudy of sexual behaviour among individuals enrolled in an open-label multicentre international randomised trial (from 2013) of immediate versus deferred ART (to CD4 cell counts of 350/µl) in people with CD4 cell counts of > 500/µl [the Strategic Timing of Antiretroviral Therapy (START) trial]; and (5) Partners of People on ART: a new Evaluation of the Risks (PARTNER), an observational multicentre longitudinal study of HIV serodifferent heterosexual and MSM couples, in which the HIV-positive partner is on ART (2010–14).Main outcome measuresThe main outcome measures were the clinical effectiveness and cost-effectiveness of a policy of immediate initiation of ART at diagnosis.ResultsBased on data from studies (i)–(v), we estimated from our modelling work that increases in condomless sex (CLS) among MSM as a whole may explain the increase in HIV infection incidence in MSM epidemics over a time when ART coverage and viral suppression increased, demonstrating the limiting effects of non-condom use on the HIV epidemic among MSM. Accordingly, an increase in the overall proportion of MSM living with HIV who are virally suppressed on ART from the current level of < 60% to 90% without increases in CLS was required to achieve a reduction in the incidence of HIV among MSM to < 1 per 1000 person-years. The incremental cost-effectiveness ratio associated with the fourfold increase in levels of HIV testing and ART at diagnosis required to provide this increase from < 60% to 90% was £20,000 if we assumed continuation of current ART prices. However, this value falls to £3500 if we assume that ART prices will fall to 20% of their current cost as a result of the introduction of generic drugs. Therefore, our evaluation suggests that ART initiation at diagnosis is likely to be highly cost-effective in MSM at a population level, particularly accounting for future lower ART costs as generic drugs are used. The impact will be much greater if levels of HIV testing can be enhanced.LimitationsIt was necessary to make some assumptions beyond the available data in order to extrapolate cost-effectiveness through modelling.ConclusionsOur findings suggest that ART initiation at diagnosis is likely to be cost-effective in MSM. Of note, after this programme of work was completed, results from the main START trial demonstrated benefit in ART initiation even in people with CD4 cell counts of > 500/µl, supporting ART initiation in people diagnosed with a HIV infection.Future workThere is a need for future research into the means of increasing the frequency with which MSM test for HIV.FundingThe National Institute for Health Research Programme Grants for Applied Research programme.

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Recreational drug use, polydrug use, and sexual behaviour in HIV-diagnosed men who have sex with men in the UK: results from the cross-sectional ASTRA study

Abstract: National Institute for Health Research.

Cited by 269 publications

References 25 publications

An observed rise in γ-hydroxybutyrate-associated deaths in London: Evidence to suggest a possible link with concomitant rise in chemsex

An observed rise in γ-hydroxybutyrate-associated deaths in London: Evidence to suggest a possible link with concomitant rise in chemsex

Predictors of crystal methamphetamine use in a community-based sample of UK men who have sex with men

Implications for a policy of initiating antiretroviral therapy in people diagnosed with human immunodeficiency virus: the CAPRA research programme

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