Question | Discussion | References | CME Credit

Updated March 14, 2006

Case 1: Methamphetamine Use and HIV

Authors: Emily Darby, MD Chinazo O. Cunningham, MD

A 32-year-old man presents to establish care at an HIV clinic after a recent admission for bacterial pneumonia. As an inpatient, he was informed that his CD4 count had declined to 220 cells/mm3, and he was urged to discuss antiretroviral treatment options. He has known of his HIV diagnosis for 3 years, but in the interim, he has only sporadically engaged in medical care. He believes he acquired HIV through sexual contact with men. Further history reveals that he smokes methamphetamine 1 to 3 times per week. On occasion, he injects methamphetamine, usually with someone else’s equipment. He assumes most of his sexual and drug-sharing partners are also HIV-infected. Physical examination is notable for a heart rate of 110, poor dentition, mild wheezing, and agitation. He admits to using methamphetamine that morning.

Which of the following statements is TRUE regarding active methamphetamine use in this HIV-infected individual?

A Chronic heavy use of methamphetamine is unlikely to increase his risk of developing chronic neurologic or psychiatric sequelae.
B His use of methamphetamine will probably not increase the likelihood that he will transmit HIV to another person.
C Methamphetamine and nucleoside reverse transcriptase inhibitors (NRTIs) do not appear to have significant drug-drug interactions.
D Pharmacologic therapy with citalopram (Celexa) is highly effective and well-established for the treatment of methamphetamine addiction.