Rising substance use linked to STI and HCV in Thai MSM after acute HIV infection


BACKGROUND: We report longitudinal trends in alcohol and recreational drug use and their associations with clinical outcomes in a Thai cohort of people living with HIV who are men who have sex with men (MSM).
METHODS: From 2017-2019, participants in the RV254/SEARCH010 cohort of acute HIV infection completed a questionnaire every 24 weeks about drug, alcohol use and group sex. Positive use was defined as 1 self-reports of substance use during a calendar year. Risky alcohol use was defined as AUDIT-C score '¥4. Logistic regression with generalized estimating equations estimated odds ratios (ORs) and 95% confidence intervals (CIs) for factors associated with recreational drug and risky alcohol use.
RESULTS: Among 604 participants with substance use data, median age was 26 years and 93.5% were MSM. Alcohol consumption was reported in 83.3% and risky alcohol use in 38.1%. Recreational drug use was reported in 46.9%. From 2017 to 2019, rising trends were observed for risky alcohol use, any recreational drug use, poppers, and methamphetamine injection (Table). New recruits to the cohort in 2017-2019 (n=137) were more likely than those enrolled between 2009 and 2016 to report methamphetamine use (30% vs. 19%, p=0.01) and injection of methamphetamine (20% vs. 3.9%, p<0.01). Participants who used recreational drugs were more likely to have hepatitis C coinfection (OR 3.42, 95%CI 1.88-6.21), syphilis coinfection (OR 2.69, 1.75-4.13), gonorrhea (OR 7.74, 5.04-11.89), chlamydia (OR 1.61, 1.12-2.31), and group sex (OR 7.74, 5.04-11.89). Methamphetamine injection was highly associated with group sex (OR 28.40, 10.99-73.41).

Table. Proportion of participants reporting substance use by calendar year
Substance All
test for trend
Alcohol503 (83.3)218 (66.5)412 (75.2)456 (76.8)0.001
AUDIT-C score '¥4230 (38.1)49 (14.9)131 (23.9)192 (32.3)<0.001
Erectile dysfunction drugs172 (28.5)50 (15.2)119 (21.7)118 (19.9)0.170
Recreational drug use (includes all below)283 (46.9)68 (20.7)191 (34.9)210 (35.4)<0.001
Poppers242 (40.1)69 (21.0)153 (27.9)173 (29.1)0.013
Ecstasy33 (5.5)5 (1.5)24 (4.4)19 (3.2)0.312
Oral amphetamines22 (3.6)2 (0.6)15 (2.7)13 (2.2)0.183
Methamphetamine129 (21.4)33 (10.1)87 (15.9)85 (14.3)0.146
Injection of methamphetamine46 (7.6)6 (1.8)24 (4.4)27 (4.5)0.061

CONCLUSIONS: Substance use has increased in Thai MSM living with HIV. Recreational drugs are strongly associated with the acquisition of sexually transmitted infections, including hepatitis C. Substance use screening at diagnosis and at every routine visit should be integrated into clinical practice for MSM with HIV in Thailand.