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Advancing the prevention and treatment of chronic illnesses

Psychoactive Drugs and HIV. Steven Shoptaw, PhD UCLA Center for Behavioral and Addiction Medicine Department of Family Medicine sshoptaw@mednet.ucla.edu September 5, 2014. Advancing the prevention and treatment of chronic illnesses.

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Advancing the prevention and treatment of chronic illnesses

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  1. Psychoactive Drugs and HIV Steven Shoptaw, PhD UCLA Center for Behavioral and Addiction Medicine Department of Family Medicine sshoptaw@mednet.ucla.edu September 5, 2014 Advancing the prevention and treatment of chronic illnesses UCLADepartment of Family Medicine

  2. What You Need to Know • Most users of substances don’t inject • Proposed mechanisms linking substance use and HIV transmission for people who do not inject • Indirect links between drug abuse treatment as HIV prevention • Two evidence-based case examples • Discussion Advancing the prevention and treatment of chronic illnesses UCLADepartment of Family Medicine

  3. Substances • Sedative/barbs – ALCOHOL, benzodiazepines, GHB • Stimulants – cocaine, speed, NICOTINE, Ecstasy (MDMA) • Opiates – heroin, percodan, dilaudid, vicodin • Hallucinogens – LSD, mescaline, peyote • Tranquilizers/anesthetics – ketamine, PCP • Cannabinoids – POT, hash • Inhalants – poppers, solvents

  4. Substance Use Prevalence, U.S. Adults 2012 www.samhsa.govNational Survey on Drug Use and Health, 2013 Advancing the prevention and treatment of chronic illnesses UCLADepartment of Family Medicine

  5. Drug Dependence in America • In 2012, 22.2 million (8.5% of adults aged 12 and over met) criteria for substance abuse or dependence not including tobacco dependence (National Survey on Drug Use and Health, 2011). • Alcohol abuse and dependence represents the majority (17.7 million; 6.8% of adults and 80% of total substance abuse/dependence) • remainder splits between drug disorders only and comorbid illicit drug use and alcohol use disorders. www.samhsa.gov NSDUH, 2013 Advancing the prevention and treatment of chronic illnesses UCLADepartment of Family Medicine

  6. A Word About Marijuana Frances Jensen and David Urion Advancing the prevention and treatment of chronic illnesses UCLADepartment of Family Medicine

  7. AIDS in America: Overlooked Epidemic Prevalence of HIV among MSM in Los Angeles County is about 19% Substance use involved in 28% to 33% of incident cases among MSM El-Sadr, Mayer, Hodder. (2010). NEJM. 362:967-970.

  8. High HIV incidence among people who inject drugs (PWID) in Eastern Europe, Central, Southeast and South Asia and Africa • Increasing importance of non-injection substance use • Globally, coverage of ART, medication assisted treatment and sterile syringes is low among PWID, due to structural barriers and unavailability • Limited HIV research among women and adolescent substance users • Growing emphasis on implementation science strategies to improve intervention coverage • Limited data to inform efficacy and timing of HIV treatment as prevention (TasP) among PWID • Limited integration of substance use into active HPTN protocols

  9. What we Know: Non-injection Stimulant Useand HIV among MSM • Non-injection stimulant use accounts for between 16% and 33% of new HIV infections among MSM in the U.S.1,2 • Consistent linkages between use of methamphetamine and binge drinking with serodiscordant unprotected anal intercourse.3 • Evidence for onset of methamphetamine use both before and after HIV seroconversion.4 1Koblin et al., AIDS 2006 2 Ostrow et al., JAIDS 2009 3 Vosburgh et al., AIDS & Behav, 2012 4 Halkitis et al, Health Psychol 2014

  10. Women, HIV and Substance Use • Females who inject drugs tend to have higher HIV prevalence than men who inject drugs5 • Among U.S. women in HPTN 064, 76% reported binge drinking or using ≥1 drug in the last 6 months6: • Binge drinking: 63% • Cocaine use: 25% • Opiates: 17% • Poly-substance users less likely to decrease frequency of use over time • 5 des Jarlais, Drug Alc Depend 2012 • 6 Kuo et al, Drug Alc Depend 2014

  11. What We Know: Emerging Substance Use Trends and HIV among Adolescents • Emerging drug trends: • Prescription drug use which may facilitate transitions to injection7 • Synthetic cannibinoids (e.g., Spice) and cathinones (e.g., bath salts); links to HIV risk under-studied • HIV incidence increased by 20% among young people (ages 15-24) in Eastern Europe between 2001 and 2011; the majority of whom use or inject drugs.8 7 UNODC, 2013 8 UNAIDS 2012

  12. New treatments for HCV, HIV, substance abuse • Once daily HCV treatments - high efficacy regimens for all genotypes provides opportunity for TasP, integrating HCV and HIV treatment approaches • Long-acting formulations for ARVs - provide opportunities for HIV treatment and prevention that sidestep medication adherence • Drug treatment as prevention - Injectable treatments for alcohol, stimulant and opioid addiction (Naltrexone, Probuphine) allow opportunities for new concepts • New developments in behavioral sciences, especially technology/social media, offer new intervention approaches

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