Depressive symptoms and substance use: Changes overtime among a cohort of HIV-positive and HIV-negative MSM

A narrative systematic review of associations and temporality between use of methamphetamine, ecstasy/MDMA, or cocaine with anxiety or depressive symptoms

OBJECTIVE

Anxiety and depression are prevalent mental health problems in people who use illicit stimulants. Improved understanding of the temporal relationship between methamphetamine, ecstasy/MDMA, or cocaine use with anxiety or depression informs public health interventions and treatment options for those experiencing this co-occurrence. This narrative systematic review sought to examine associations and temporality between the use of methamphetamine, ecstasy/MDMA, or cocaine, with anxiety or depressive symptoms. Method Systematic searches of 4 electronic databases were conducted up to August 2023. Study eligibility included the measurement of anxiety and/or depressive symptoms, and frequency of illicit stimulant use (methamphetamine, cocaine, or ecstasy/MDMA) at two separate time points, with data analysis of the association between these variables. The Joanna Briggs Critical Appraisal Checklist was utilised to assess quality. Data was extracted, and a narrative synthesis incorporating an eight-criteria framework to assess associations was conducted. Results 4432 studies were screened for eligibility; 11 studies (3 RCTs and 8 prospective cohort studies) were included. Evidence for an association between depressive symptoms and methamphetamine use was demonstrated in six studies, with temporal evidence in three studies supporting methamphetamine use preceding depressive symptoms. Three studies reported an association between cocaine use and depressive symptoms. Evidence for associations with any of the illicit stimulants and anxiety symptoms was lacking.

CONCLUSIONS

There was some evidence to support a case for temporality, particularly for methamphetamine use and depressive symptoms. Investing in longitudinal studies is pivotal to understanding the dynamic and reciprocal relationship between illicit stimulant use and anxiety or depressive symptoms. A limitation of the study was the variation in the measurement and analysis of outcomes.

HIV-Related Stigma and Treatment Adherence Among Gay, Bisexual, and Other Men Who Have Sex with Men Who Use Crystal Meth in the Metropolitan Area of Mexico City

Internationally, HIV-related stigma and crystal methamphetamine (meth) use have been described as barriers to treatment adherence among gay, bisexual, and other men who have sex with men (gbMSM). Crystal meth use has been increasing among gbMSM in the Metropolitan Area of Mexico City (MAMC). Therefore, this study aimed to determine the association between HIV-related stigma and HIV treatment adherence among gbMSM who use crystal meth in the MAMC. This study was undertaken as part of an exploratory study of crystal meth use in the MAMC. The data were collected from September to December 2021 through an encrypted online survey. Participants (n = 89) were gbMSM adults living with HIV who reported crystal meth use in the past month that were recruited through an online snowball sampling. The online survey included questions about HIV treatment adherence, sexual behaviors, the Alcohol, Smoking, and Substance Involved Screening Test, and the HIV-Related Stigma Mechanisms Scale. Logistic regression analyses assessed the association between HIV-related stigma and HIV treatment adherence. The multivariate logistic regression model showed that, controlling for health insurance [adjusted odds ratio (AOR) = 0.13; 95% confidence intervals (CI)  = 0.02-0.59] and educational level (AOR = 0.16; 95% CI = 0.02-0.88), non-adherence to HIV treatment was independently associated with higher HIV-related stigma (AOR = 1.06; 95% CI = 1.01-1.12). Public health policies must include HIV-related stigma and substance use in treating gbMSM with HIV.

Association of current substance use treatment with future reduced methamphetamine use in an observational cohort of men who have sex with men in Los Angeles

INTRODUCTION

Methamphetamine use is highly prevalent among men who have sex with men (MSM), but knowledge of the long-term dynamics, and how they are affected by substance use treatment, is limited. This study aimed to describe trajectories of methamphetamine use among MSM, and to evaluate the impact of treatment for any kind of substance use on frequency of methamphetamine use.

METHODS

This analysis used data from a cohort of MSM in Los Angeles, CA, who participated in semi-annual study visits from 2014 to 2022. The study characterized trajectories of methamphetamine use using a continuous time multistate Markov model with three states. States were defined using self-reported frequency of methamphetamine use in the past six months: frequent (daily), occasional (weekly or less), and never. The model estimated the association between receiving treatment for any kind of substance use and changes in state of frequency of methamphetamine use.

RESULTS

This analysis included 2348 study visits among 285 individuals who were followed-up for an average of 4.4 years. Among participants who were in the frequent use state, 65 % (n = 26) of those who were receiving any kind of substance use treatment at a study visit had reduced their methamphetamine use at their next visit, compared to 33 % (n = 95) of those who were not receiving treatment. Controlling for age, race/ethnicity, and HIV-status, those who reported receiving current treatment for substance use were more likely to transition from occasional to no use (HR: 1.63, 95 % CI: 1.10-2.42) and frequent to occasional use (HR: 4.25, 95 % CI: 2.11-8.59) in comparison to those who did not report receiving current treatment for substance use.

CONCLUSIONS

Findings from this dynamic modeling study provide a new method for assessing longitudinal methamphetamine use outcomes and add important evidence outside of clinical trials that substance use treatment may reduce methamphetamine use.

Depressive Symptoms, the Impact on ART Continuation, and Factors Associated with Symptom Improvement Among a Cohort of People Living with HIV in British Columbia, Canada

Depressive symptoms among people living with HIV (PLWH) are associated with poorer overall health outcomes. We characterized depressive symptoms and improvements in symptomology among PLWH (≥ 19 years old) in British Columbia (BC), Canada. We also examined associations between depressive symptomology and antiretroviral therapy (ART) treatment interruptions. Depressive symptoms were measured using the 10-item Center for Epidemiologic Studies Depression Scale (CES-D-10), within a longitudinal cohort study with three surveys administered 18-months apart. We used multivariable logistic regression to model factors associated with improvements in depressive symptoms (CES-D-10 scores from ≥ 10 to < 10). Of the 566 participants eligible for analysis 273 (48.2%) had CES-D scores indicating significant depressive symptoms (score ≥ 10) at enrollment. Improvements in symptoms at first follow-up were associated with greater HIV self-care on the Continuity of Care Scale (adjusted odds ratio: 1.17; 95% CI 1.03-1.32), and not having a previously reported mental health disorder diagnosis (aOR 2.86; 95% CI 1.01-8.13). Those reporting current cocaine use (aOR 0.33; 95% CI 0.12-0.91) and having a high school education, vs. less than, (aOR 0.25; 95% CI 0.08-0.82) had lower odds of improvement in depressive symptomatology. CES-D scores ≥ 10 were not significantly associated with ART treatment interruptions during follow-up (aOR: 1.08; 95% CI:0.65-1.8). Supporting greater self-care and consideration of mental health management strategies in relation to HIV may be useful in promoting the wellbeing of PLWH who experience depressive symptoms.

Overamped: Stimulant Use and HIV Pathogenesis

PURPOSE OF REVIEW

In the era of HIV treatment as prevention (TasP), more clarity is needed regarding whether people with HIV who use stimulants (i.e., methamphetamine, powder cocaine, and crack cocaine) display elevated HIV viral load and greater immune dysregulation.

RECENT FINDINGS

Although rates of viral suppression have improved in the TasP era, stimulant use was independently associated with elevated viral load in 23 of 28 studies included in our review. In the 12 studies examining other HIV disease markers, there was preliminary evidence for stimulant-associated alterations in gut-immune dysfunction and cellular immunity despite effective HIV treatment. Studies generally focused on documenting the direct associations of stimulant use with biomarkers of HIV pathogenesis without placing these in the context of social determinants of health. Stimulant use is a key barrier to optimizing the effectiveness of TasP. Elucidating the microbiome-gut-brain axis pathways whereby stimulants alter neuroimmune functioning could identify viable targets for pharmacotherapies for stimulant use disorders. Examining interpersonal, neighborhood, and structural determinants that could modify the associations of stimulant use with biomarkers of HIV pathogenesis is critical to guiding the development of comprehensive, multi-level interventions.

Trajectories of depressive symptoms in young and middle-aged men who have sex with men with new HIV-diagnosis: a 1-year prospective cohort study in Beijing, China

Introduction

Due to the sexual orientation and HIV diagnosis, young and middle-aged men who have sex with men (MSM) with new HIV-diagnosis may experience more depressive syndromes and face greater psychological stress. The study explored trajectories of depressive symptoms of young and middle-aged MSM within 1 year after new HIV-diagnosis and analyze the related factors.

Methods

From January 2021 to March 2021, 372 young and middle-aged MSM who were newly diagnosed as HIV-infection were recruited in two hospitals in Beijing. Self-rating Depression Scale was used to measure the participants' depressive symptom in 1st month, 3rd month, 6th month, 9th month and 12th month after HIV diagnosis. The latent class growth model was used to identify trajectories of the participants' depressive symptoms. Multinomial logistic regression was used to analyse factors related with the trajectories.

Results

Three hundred and twenty-eight young and middle-aged MSM with new HIV-diagnosis completed the research. Depressive symptom in 328 young and middle-aged MSM was divided into three latent categories: non-depression group (56.4%), chronic-mild depression group (28.1%), and persistent moderate-severe depression group (15.5%). The participants assessed as non-depression (non-depression group) or mild depression (chronic-mild depression group) at the baseline were in a non-depression state or had a downward trend within one-year, and the participants assessed as moderate and severe depression (persistent moderate-severe depression group) at the time of diagnosis were in a depression state continuously within 1-year. Multinomial logistic regression analysis showed that, compared with the non-depression group, monthly income of 5,000 ~ 10,000 RMB (equal to 690 ~ 1,380 USD) was the risk factor for the chronic-mild depression group, and self-rating status being fair/good and self-disclosure of HIV infection were protective factors for the persistent moderate-severe depression group while HIV-related symptoms was the risk factor.

Conclusion

Depressive symptoms in young and middle-aged MSM is divided into three latent categories. Extra care must be given to young and middle-aged MSM assessed as moderate or severe depression at the time of HIV-diagnosis, especially to those who had poor self-rating health status, did not tell others about their HIV-infection and experienced HIV-related symptoms.

Methamphetamine exposure and depression-A systematic review and meta-analysis

ISSUES

Methamphetamine use is a public health concern that has been associated with comorbid mental health problems. We aim to better understand the relationship between methamphetamine use and depression by: (i) systematically reviewing and meta-analysing the risks of depression by methamphetamine use; and (ii) investigating the risk of unmeasured confounding.

APPROACH

A systematic review and meta-analysis were conducted following PRISMA guidelines. EMBASE, PsycINFO and PubMed were searched to identify human studies reporting on the association between methamphetamine or amphetamine use and depressive outcomes. The data were summarised narratively and meta-analysed, stratified by cross-sectional and longitudinal estimates. Unmeasured confounding was assessed by E-values analyses.

KEY FINDINGS

From the 6606 studies that came up from the search, 14 eligible studies were included in the narrative review and had data for meta-analysis. A significant association was found between any use of methamphetamine and any depression outcomes in cross-sectional (odds ratio [OR] = 1.66 [95% confidence interval [CI] 1.34, 2.05]) and longitudinal estimates (OR = 1.18 [95% CI 1.08, 1.28]). People with a methamphetamine use disorder had significantly higher odds of depression than those without (OR = 2.80 [95% CI 1.40, 5.90]). The E-values ranged from 1.28 to 6.30 for cross-sectional studies and from 2.37 to 3.21 for longitudinal studies.

CONCLUSION

Based on limited data, people who used methamphetamine have higher odds of depression than people who do not. There were mostly a low to moderate risk of unmeasured confounding in the longitudinal study results. Future longitudinal studies conducted using causal framework methods are warranted.

Comparing Factors Associated with Increased Stimulant Use in Relation to HIV Status Using a Machine Learning and Prediction Modeling Approach

Stimulant use is an important driver of HIV/STI transmission among men who have sex with men (MSM). Evaluating factors associated with increased stimulant use is critical to inform HIV prevention programming efforts. This study seeks to use machine learning variable selection techniques to determine characteristics associated with increased stimulant use and whether these factors differ by HIV status. Data from a longitudinal cohort of predominantly Black/Latinx MSM in Los Angeles, CA was used. Every 6 months from 8/2014-12/2020, participants underwent STI testing and completed surveys evaluating the following: demographics, substance use, sexual risk behaviors, and last partnership characteristics. Least absolute shrinkage and selection operator (lasso) was used to select variables and create predictive models for an interval increase in self-reported stimulant use across study visits. Mixed-effects logistic regression was then used to describe associations between selected variables and the same outcome. Models were also stratified based on HIV status to evaluate differences in predictors associated with increased stimulant use. Among 2095 study visits from 467 MSM, increased stimulant use was reported at 20.9% (n = 438) visits. Increased stimulant use was positively associated with unstable housing (adjusted [a]OR 1.81; 95% CI 1.27-2.57), STI diagnosis (1.59; 1.14-2.21), transactional sex (2.30; 1.60-3.30), and last partner stimulant use (2.21; 1.62-3.00). Among MSM living with HIV, increased stimulant use was associated with binge drinking, vaping/cigarette use (aOR 1.99; 95% CI 1.36-2.92), and regular use of poppers (2.28; 1.38-3.76). Among HIV-negative MSM, increased stimulant use was associated with participating in group sex while intoxicated (aOR 1.81; 95% CI 1.04-3.18), transactional sex (2.53; 1.40-2.55), and last partner injection drug use (1.96; 1.02-3.74). Our findings demonstrate that lasso can be a useful tool for variable selection and creation of predictive models. These results indicate that risk behaviors associated with increased stimulant use may differ based on HIV status and suggest that co-substance use and partnership contexts should be considered in the development of HIV prevention/treatment interventions.

Depressive symptoms, perceived social support, and anticipated HIV stigma among HIV-negative/unknown men who have sex with men in China during the COVID-19 pandemic: A multicenter online cross-sectional study

OBJECTIVE

To investigate the prevalence of depressive symptoms among human immunodeficiency virus (HIV)-negative/unknown men who have sex with men (MSM) in China and explore the relationship between perceived social support, anticipated HIV stigma, and depressive symptoms.

METHODS

Participants in this study were recruited from a gay social networking app (Blued) in China by convenience sampling from December 16, 2020 to March 1, 2021. Perceived Social Support Questionnaire, Anticipated HIV Stigma Questionnaire, and Center for Epidemiologic Studies Depression Scale were used to measure the social support, anticipated HIV stigma, and depressive symptoms of participants. Confirmatory factor analysis was performed to assess the reliability and validity of the measurement model. Structural equation modeling was employed to evaluate the association of perceived social support, anticipated HIV stigma, and depressive symptoms, as well as the mediation effects.

RESULTS

Overall, 47.70% (665/1394) of the participants had depressive symptoms. Perceived social support could have both direct and indirect effects on depressive symptoms with the mediating role of anticipated HIV stigma among HIV-negative/unknown MSM.

CONCLUSION

Tailored interventions regarding perceived social support and anticipated HIV stigma, such as group therapy, mutual support groups and mindfulness training, with the involvement of non-governmental or governmental organizations, should be taken into account to reduce depressive symptoms and stigma among HIV-negative/unknown MSM in China.

Grit is associated with psychological health among older sexual minority men

Objectives: Studies have shown that grit-defined as perseverance and passion for achieving one's long-term goals-is associated with improved health outcomes, including lower levels of psychological distress. However, the psychometric properties of the original Grit Scale (Grit-O Scale) has not been validated among sexual minority men (SMM). The present study aimed to validate the Grit-O Scale among a sample of older SMM and assess the relationships between the Grit-O Scale factors and symptoms of psychological distress.Method: We used data from a single visit of participants in the Multicenter AIDS Cohort Study (MACS) Healthy Aging longitudinal study. The sample included 981 older SMM (mean age = 61, SD = 8.5) with and without HIV. We conducted confirmatory factor analysis (CFA) to identify the two factors of the Grit-O Scale: consistency of interest and perseverance of effort. We also conducted a latent profile analysis (LPA) to identify distinct profiles of psychological distress from self-reported scales of depression, anxiety, and perceived stress.Results:The Grit-O Scale showed acceptable reliability estimates for the items with Cronbach's alpha reliability coefficients ranging from 0.77 to 0.82. The CFA identified the two factors of the Grit-O Scale with acceptable model fit (root mean square error of approximation = 0.058 [95% CI = 0.050, 0.067], comparative fit index = 0.95, Tucker-Lewis Index = 0.93, standardized root mean square residual = 0.07). The LPA yielded three mutually exclusive profiles of psychological distress (profile 1: low stress, anxiety, and depression; profile 2: high stress and depression and low anxiety; and profile 3: high stress, anxiety, and depression). In adjusted multinominal logistic regression analysis, we found that both higher levels of consistency of interest and perseverance of effort factors of the Grit-O Scale were significantly associated with decreased odds of being in profiles 2 and 3 compared with being in profile 1.Conclusion: Our findings support the use of the Grit-O Scale among older SMM. Grit factors could explain variability in the negative psychological symptoms among older SMM and warrant further investigation.Supplemental data for this article is available online at http://dx.doi.org/10.1080/13607863.2022.2032594.

Biopsychosocial approach to understanding determinants of depression among men who have sex with men living with HIV: A systematic review

INTRODUCTION

Men who have sex with men (MSM) living with HIV are more likely to be depressed than MSM without HIV. The AIDS epidemic will not end if the needs of people living with HIV and the determinants of health are not being addressed. Compared to HIV individuals without depression, depressed HIV individuals have worse clinical outcomes and higher mortality risk. Depression is caused by a complex combination of social, psychological, and biological variables. This systematic review, thereby motivated by the need to address this gap in the literature, aims to articulate determinants of depression among MSM living with HIV according to the biopsychosocial approach.

METHODOLOGY

We systematically searched four databases from 2011 to 2021. We searched for observational studies on determinants of depression among MSM living with HIV. The outcome is depression based on the categorical or numerical outcome. Two reviewers independently extracted data and assessed study risks of bias. Any disagreements are consulted with the third reviewer.

RESULTS

We identified 533 articles, of which only eight studies are included. A total of 3,172 MSMs are included in the studies. We found the determinants of depression and categorized them according to biological, psychological, and social approaches.

CONCLUSION

The determinants of depression with the strongest evidence across studies were enacted HIV-related stigma, unemployment, sleep disturbance, current smoker, black ethnicity, born overseas, ART initiation, and access to mental health care. Despite weaker evidence, the other relevant determinants to be included were older age, internalized stigma, self-efficacy, and social support. Efforts to improve or prevent depression among MSM living with HIV could benefit from addressing the determinants of depression based on the biopsychosocial approach immediately after HIV diagnosis. Integrating mental health screening and care into HIV treatment settings would strengthen HIV prevention and care outcomes and improve access to mental healthcare.

Comparing single and multiple imputation strategies for harmonizing substance use data across HIV-related cohort studies

Background

Although standardized measures to assess substance use are available, most studies use variations of these measures making it challenging to harmonize data across studies. The aim of this study was to evaluate the performance of different strategies to impute missing substance use data that may result as part of data harmonization procedures.

Methods

We used self-reported substance use data collected between August 2014 and June 2019 from 528 participants with 2,389 study visits in a cohort study of substance use and HIV. We selected a low (heroin), medium (methamphetamine), and high (cannabis) prevalence drug and set 10–50% of each substance to missing. The data amputation mimicked missingness that results from harmonization of disparate measures. We conducted Monte Carlo simulations to evaluate the comparative performance of single and multiple imputation (MI) methods using the relative mean bias, root mean square error (RMSE), and coverage probability of the 95% confidence interval for each imputed estimate.

Results

Without imputation (i.e., listwise deletion), estimates of substance use were biased, especially for low prevalence outcomes such as heroin. For instance, even when 10% of data were missing, the complete case analysis underestimated the prevalence of heroin by 33%. MI, even with as few as five imputations produced the least biased estimates, however, for a high prevalence outcome such as cannabis with low to moderate missingness, performance of single imputation strategies improved. For instance, in the case of cannabis, with 10% missingness, single imputation with regression performed just as well as multiple imputation resulting in minimal bias (relative mean bias of 0.06% and 0.07% respectively) and comparable performance (RMSE = 0.0102 for both and coverage of 95.8% and 96.2% respectively).

Conclusion

Our results from imputation of missing substance use data resulting from data harmonization indicate that MI provided the best performance across a range of conditions. Additionally, single imputation for substance use data performed comparably under scenarios where the prevalence of the outcome was high and missingness was low. These findings provide a practical application for the evaluation of several imputation strategies and helps to address missing data problem when combining data from individual studies.

Interruptions in Mental Health Care, Cannabis Use, Depression, and Anxiety during the COVID-19 Pandemic: Findings from a Cohort of HIV-Positive and HIV-Negative MSM in Los Angeles, California

The objective was to examine the impact of the COVID-19 pandemic on mental health care, cannabis use, and behaviors that increase the risk of STIs among men living with or at high risk for HIV. Data were from mSTUDY - a cohort of men who have sex with men in Los Angeles, California. Participants who were 18 to 45 years and a half were HIV-positive. mSTUDY started in 2014, and at baseline and semiannual visits, information was collected on substance use, mental health, and sexual behaviors. We analyzed data from 737 study visits from March 2020 through August 2021. Compared to visits prior to the COVID-19 pandemic, there were significant increases in depressive symptomatology (CES-D ≥ 16) and anxiety (GAD-7 ≥ 10). These increases were highest immediately following the start of the pandemic and reverted to pre-pandemic levels within 17 months. Interruptions in mental health care were associated with higher substance use (especially cannabis) for managing anxiety/depression related to the pandemic (50% vs. 31%; p-value < .01). Cannabis use for managing pandemic-related anxiety/depression was higher among those reporting changes in sexual activity (53% vs. 36%; p-value = 0.01) and was independently associated with having more than one sex partner in the prior 2 weeks (adjusted OR = 1.5; 95% CI 1.0-2.4). Our findings indicate increases in substance use, in particular cannabis, linked directly to experiences resulting from the COVID-19 pandemic and the associated interruptions in mental health care. Strategies that deliver services without direct client contact are essential for populations at high risk for negative sexual and mental health outcomes.

Short-term binge drinking, marijuana, and recreational drug use trajectories in a prospective cohort of people living with HIV at the start of COVID-19 mitigation efforts in the United States

BACKGROUND

At the start of the COVID-19 pandemic, HIV experts suggested that an increase in mental health diagnoses and substance use among people living with HIV (PLHIV) may be an unintended consequence of COVID-19 mitigation efforts (e.g., limiting social contact). We evaluated short-term trajectories in binge drinking, marijuana, and recreational drug use in a prospective cohort of PLHIV.

METHODS

Data (N = 2121 PLHIV) consist of survey responses on substance use behaviors from two pre-COVID-19 (October 2018-September 2019) and one COVID-19-era (April 2020-September 2020) timepoints within the MACS/WIHS Combined Cohort Study (MWCCS). We conducted group-based trajectory models, triangulated with generalized linear mixed models, to assess changes in binge drinking, daily marijuana use, and recreational drug use at the start of the pandemic. Controlling for age and race/ethnicity, we tested whether trajectories differed by sex and early-pandemic depressive symptoms, loneliness, and social support.

RESULTS

Group-based trajectory models yielded two trajectory groups for binge drinking (none vs. any), marijuana (none/infrequent vs. daily), and recreational drug use (none vs. any). Binge drinking and recreational drug use decreased at the beginning of the pandemic. Generalized linear mixed model supported these trends. Consistent with prior research, male sex and having depressive symptoms early pandemic were positively associated with each substance use outcomes. Social support was inversely associated with recreational drug use.

CONCLUSIONS

Contrary to hypotheses, problematic substance use behaviors decreased from pre-pandemic to the post-pandemic follow-up in our sample of PLHIV. Ongoing surveillance is needed to assess whether this pattern persists as the pandemic continues.

Prevalence and related factors of depressive symptoms among HIV/AIDS in Ningbo, China: A cross-sectional study

BACKGROUND

Depressive symptoms were common among HIV/AIDS patients. Previous studies had shown that HIV-infected patients were twice as likely to be diagnosed with depression as the general population. However, only few studies have explored the prevalence and related factors of depressive symptoms among HIV/AIDS in China.

MATERIALS AND METHODS

A cross-sectional study was conducted to study the prevalence of depressive symptoms among HIV/AIDS from January to December 2021 through the database of HIV/AIDS antiretroviral therapy and psychological evaluation system in Ningbo, China. The Patient Health Questionnaire-2 (PHQ-2) was used to screen for depressive symptoms (PHQ-2 > 0), the Patient Health Questionnaire-9 (PHQ-9) was used to diagnose depressive symptoms, and multivariate Logistic regression model was carried on to evaluate the related factors.

RESULTS

A total of 3,939 HIV/AIDS patients were enrolled, and the age of initiation of antiretroviral therapy was 37.15 (IQR = 28.41-48.73) years. Among them, 3,230 (82.00%) were male, 3,844 (97.59%) were Han nationality, 1,391 (35.49%) were unmarried, 1,665 (42.27%) were homosexual transmission, and 2,194 (55.70%) were HIV-infected patients. There were 265 patients (6.73%) with depressive symptoms, and the proportion of mild, moderate, moderate and severe depressive symptoms was 4.01% (158/3939), 1.65% (65/3939), 0.76% (30/3939), and 0.30% (12/3939), respectively. Multivariate analysis showed that married [odds ratio (OR) = 0.675, 95% CI = 0.501-0.908], divorced or widowed (OR = 0.571, 95% CI = 0.380-0.860), homosexual transmission (OR = 1.793, 95% CI = 1.349-2.396) were associated with depressive symptoms among HIV/AIDS.

CONCLUSION

The prevalence of depressive symptoms among HIV/AIDS patients was 6.73% in Ningbo, China. More attention should be paid to the psychological status of unmarried and homosexual HIV/AIDS patients in Ningbo and timely psychological intervention or treatment should be given to those patients with depressive symptoms.

Optimizing outpatient treatment outcomes among methamphetamine-using gay and bisexual men through a computerized depression intervention

INTRODUCTION

Depression is a common sequelae of frequent methamphetamine use, and may influence rates of engagement in sexual risk-taking among methamphetamine-using cisgender gay, bisexual, and other men who have sex with men (GBMSM). The study team hypothesized that layering a brief, computerized depression intervention (i.e., MoodGym; based on Cognitive Behavioral Therapy [CBT] and Interpersonal Therapy) on top of a long-running outpatient methamphetamine treatment program (based on CBT and Contingency Management) for GBMSM could optimize reductions in methamphetamine use and sexual risk-taking among program participants.

METHODS

This pilot study, which also included analysis of historical data, employed nearest-neighbor matching algorithms to match current pilot study participants (N = 39) to prior participants of an outpatient methamphetamine treatment program (N = 703) and employed treatment effects analyses to determine the observed effects of adding depression intervention content to GBMSM-specific methamphetamine treatment.

RESULTS

Pilot study participants who received the MoodGym intervention were significantly less likely to submit methamphetamine-metabolite positive urine samples (Adjusted Treatment Effect [ATE] = -0.72; p < 0.01), and evidenced significantly greater reductions in receptive condomless anal intercourse with non-primary partners in the past 30 days (ATE = -1.39; p < 0.05), relative to prior participants of the outpatient methamphetamine treatment program who did not receive depression intervention content.

CONCLUSION

Preliminary results suggest layering a brief computerized depression intervention onto outpatient methamphetamine treatment for GBMSM may optimize reductions in methamphetamine use and/or sexual risk-taking.

Synergistic Impairment of the Neurovascular Unit by HIV-1 Infection and Methamphetamine Use: Implications for HIV-1-Associated Neurocognitive Disorders

The neurovascular units (NVU) are the minimal functional units of the blood-brain barrier (BBB), composed of endothelial cells, pericytes, astrocytes, microglia, neurons, and the basement membrane. The BBB serves as an important interface for immune communication between the brain and peripheral circulation. Disruption of the NVU by the human immunodeficiency virus-1 (HIV-1) induces dysfunction of the BBB and triggers inflammatory responses, which can lead to the development of neurocognitive impairments collectively known as HIV-1-associated neurocognitive disorders (HAND). Methamphetamine (METH) use disorder is a frequent comorbidity among individuals infected with HIV-1. METH use may be associated not only with rapid HIV-1 disease progression but also with accelerated onset and increased severity of HAND. However, the molecular mechanisms of METH-induced neuronal injury and cognitive impairment in the context of HIV-1 infection are poorly understood. In this review, we summarize recent progress in the signaling pathways mediating synergistic impairment of the BBB and neuronal injury induced by METH and HIV-1, potentially accelerating the onset or severity of HAND in HIV-1-positive METH abusers. We also discuss potential therapies to limit neuroinflammation and NVU damage in HIV-1-infected METH abusers.

Food insecurity partially mediates the association between drug use and depressive symptoms among men who have sex with men in Los Angeles, California

OBJECTIVE

To understand the relationship between drug use, food insecurity (FI) and mental health among men who have sex with men (MSM).

DESIGN

Cohort study (2014-2019) with at least one follow-up.

SETTING

Visits at 6-month intervals included self-assessment for FI and depressive symptoms. Urine testing results confirmed drug use. Factors associated with FI were assessed using multiple logistic regression with random effects for repeated measures. General structural equation modelling tested whether FI mediates the relationship between drug use and depressive symptoms.

PARTICIPANTS

Data were from HIV-positive and high-risk HIV-negative MSM in Los Angeles, CA (n 431; 1192 visits).

RESULTS

At baseline, FI was reported by 50·8 % of participants, depressive symptoms in 36·7 % and 52·7 % of urine screening tests were positive for drugs (i.e. marijuana, opioids, methamphetamine, cocaine and ecstasy). A positive drug test was associated with a 96 % increase in the odds of being food insecure (95 % CI 1·26, 3·07). Compared to those with high food security, individuals with very low food security have a nearly sevenfold increase in the odds of reporting depressive symptoms (95 % CI 3·71, 11·92). Findings showed 14·9 % of the association between drug use (exposure) and depressive symptoms (outcome) can be explained by FI (mediator).

CONCLUSION

The prevalence of FI among this cohort of HIV-positive and high-risk HIV-negative MSM was high; the association between drug use and depressive symptoms was partially mediated by FI. Findings suggest that enhancing access to food and nutrition may improve mood in the context of drug use, especially among MSM at risk for HIV transmission.

Delineating patterns of sexualized substance use and its association with sexual and mental health outcomes among young gay, bisexual and other men who have sex with men in Singapore: a latent class analysis

BACKGROUND

Young gay, bisexual, and other men who have sex with men (YMSM) are vulnerable to the risks associated with sexualized substance use. This is a novel study in Singapore that aims to classify patterns of sexualized substance use among YMSM, and investigate its association with sexual and mental health outcomes.

METHODS

In this cross-sectional study among 570 YMSM aged 18 to 25 years old, latent class analysis (LCA) conducted to identify classes with similar patterns of sexualized substance use, across which measures of inconsistent condom use, recent STI diagnoses, past suicide ideation and depression severity were compared.

RESULTS

LCA revealed three classes of YMSM based on types of substances ever used in sexualized contexts, which we labelled as 'substance-naive', 'substance-novice', and 'chemsex'. Substance-naive participants (n = 404) had only ever used alcohol, while substance-novice participants (n = 143) were primarily amyl nitrite users with a small proportion who reported using chemsex-related drugs. Chemsex participants (n = 23) comprised individuals who had mostly used such drugs. Those in the chemsex group were more likely to report recent unprotected anal sex with casual partners (aPR = 3.28, 95%CI [1.85, 5.79]), depression severity (aβ = 3.69, 95%CI [0.87, 6.51]) and a history of suicide ideation (aPR = 1.64, 95%CI [1.33, 2.03]).

CONCLUSIONS

Findings of this study highlight how the use of varying substances in sexualized contexts may be classified and characterized by different sexual and mental health outcomes. Health promotion efforts should be differentiated accordingly to address the risks associated with sexualized substance use among YMSM.

Blue Monday: Co-occurring Stimulant Use and HIV Persistence Predict Dysregulated Catecholamine Synthesis

BACKGROUND

This longitudinal study examined whether co-occurring stimulant use and HIV disease processes predicted greater risk for depression via dysregulated metabolism of amino acid precursors for neurotransmitters.

METHODS

In total, 110 sexual minority men (ie, gay, bisexual, and other men who have sex with men) living with HIV who had biologically confirmed recent methamphetamine use were enrolled in a randomized controlled trial. The kynurenine/tryptophan (K/T) and phenylalanine/tyrosine (P/T) ratios were measured over 15 months to index dysregulated metabolism of amino acid precursors for serotonin and catecholamines. Markers of gut-immune dysregulation such as lipopolysaccharide binding protein and soluble CD14 (sCD14), HIV persistence in immune cells (ie, proviral HIV DNA), and stimulant use were examined as predictors. These bio-behavioral measures, including the K/T and P/T ratios, were also examined as predictors of greater risk for depression over 15 months.

RESULTS

Higher time-varying sCD14 levels (β = 0.13; P = 0.04) and time-varying detectable viral loads (β = 0.71; P < 0.001) were independent predictors of a higher K/T ratio. Time-varying reactive urine toxicology results for stimulants (β = 0.53; P < 0.001) and greater proviral HIV DNA at baseline (β = 0.34; P < 0.001) independently predicted an increased P/T ratio. Greater time-varying, self-reported methamphetamine use uniquely predicted higher odds of screening positive for depression (Adjusted Odds Ratio = 1.08; 95% confidence interval: 1.01 to 1.17).

CONCLUSIONS

Ongoing stimulant use and HIV persistence independently predict dysregulated metabolism of amino acid precursors for catecholamines, but this did not explain amplified risk for depression.

Tryptophan depletion predicts lower positive affect in sexual minority men living with HIV who use methamphetamine

This longitudinal study with 76 sexual minority men living with HIV who use methamphetamine examined whether dysregulation of essential amino acid precursors for neurotransmitters at baseline predicted positive and negative affect at 15 months. After controlling for covariates including baseline positive affect, a higher baseline kynurenine/tryptophan (K/T) ratio independently predicted lower positive affect at 15 months (β = - 18.31; 95% CI = - 35.35, - 1.27; p = 0.036). Future clinical research should examine whether bio-behavioral interventions targeting tryptophan degradation could optimize treatments for people living with co-occurring HIV and stimulant use disorders.

An update on drug-drug interactions between antiretroviral therapies and drugs of abuse in HIV systems

INTRODUCTION

While considerable progress has been made in the fight against HIV/AIDS, to date there has not been a cure, and millions of people around the world are currently living with HIV/AIDS. People living with HIV/AIDS have substance abuse disorders at higher rates than non-infected individuals, which puts them at an increased risk of drug-drug interactions.

AREAS COVERED

Potential drug-drug interactions are reviewed for a variety of potential drugs of abuse, both licit and illicit. These drugs include alcohol, cigarettes or other nicotine delivery systems, methamphetamine, cocaine, opioids, and marijuana. Potential interactions include decreased adherence, modulation of drug transporters, or modulation of metabolic enzymes. We also review the relative incidence of the use of these drugs of abuse in People living with HIV/AIDS.

EXPERT OPINION

Despite considerable improvements in outcomes, disparities in outcomes between PLWHA who use drugs of abuse, vs those who do not still exist. It is of critical necessity to improve outcomes in these patients and to work with them to stop abusing drugs of abuse.

Depression and HIV Transmission Risk among Methamphetamine-Using Men who have Sex with Men

BACKGROUND

Methamphetamine use is associated with disproportionate risk of HIV infection and increased risk of depression among sexual minority men. The purpose of the study was to estimate the association between clinical depression diagnoses and sexual risk-taking among cisgender men who have sex with men (MSM) who use methamphetamine.

METHOD

From March 2014 through January 2016, 286 MSM who use methamphetamine but were not seeking treatment for methamphetamine use disorder were enrolled to participate in a technology-based randomized controlled trial to reduce methamphetamine use and HIV sexual risk behaviors; participants were assessed for major depressive episodes (MDE) and persistent depressive disorder (PDD) at baseline. Multivariate clustered zero-inflated negative binomial regression analyses of condomless anal intercourse (n=282; 1,248 visits) estimated the association between this baseline diagnostic result and engagement in sexual risk-taking over time.

RESULTS

Participants predominantly identified as non-white (80%), averaged 42 years of age, and reported a HIV prevalence rate of 46%. Engagement in sexual risk-taking consistently demonstrated a positive curvilinear relationship with clinical depression severity, such that, for example, participants without clinical depression (59% of the sample; coef.=1.16) and those with MDE (36% of the sample; coef.=1.45) both demonstrated elevated rates of condomless anal sex with anonymous partners relative to participants with PDD (5% of the sample; analytical reference category; both coef. p<0.05). Data also demonstrated a trend (p = 0.053) of reduced sexual risk-taking with main partners among participants diagnosed with MDE (coef.=-0.94).

CONCLUSIONS

Methamphetamine use among participants in this study inverted the functional form of the relationship between depression and sexual risk among MSM observed in prior studies. Whereas low-grade depression has been associated with increased sexual risk-taking in prior samples of MSM, methamphetamine upends this relationship, such that the greatest engagement in sexual risk-taking occurred among those diagnosed with MDE at baseline. Additional research is warranted to clarify how methamphetamine influences sexual risk-taking among MSM with/without comorbid depression.