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The authors note that the incidence of methamphetamine use has been increasing significantly in the US and Europe, with increased use of more potent amphetamines such as M.M.A. in particular among urban gay men. They also note that the drug is not well-tolerated by many patients and that its toxicity is well documented. There is an impact on the capacity of patients to take HIV drugs and protease inhibitor therapy. Methamphetamine is, however, not a great discerner between HIV-infected and uninfected people because there is no known direct effect on the HIV virus itself.

The investigators caution that no evidence is yet available that it is more likely to be safe to take HIV drugs with the inclusion of methamphetamine use during an antiretroviral therapy regimen. However, they point out that over the past 5 years the drugs have been removed from some treatment guidelines as a cause of transient steatohepatitis that can lead to liver problems. Methamphetamine use has also been linked to increased rates of prostate cancer.

Perhaps most importantly, the authors note that treatment with some HIV drugs, including some protease inhibitors such as lopinavir and ritonavir, is significantly limited or even impossible if an amphetamine (or methamphetamine derivative) is included in the patient’s drug regimen. The absorption of the drug is faster than its metabolism, and the impact on the gut is increased because the drug is metabolised at the site in the body where it is administered. This prolongs the treatment and reduces the dose that patients can safely take.

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