Amphetamine‐type stimulants and HIV infection among men who have sex with men: implications on HIV research and prevention from a systematic review and meta‐analysis

HIV infections and the use of amphetamine‐type stimulants (ATS) among men who have sex with men (MSM) have been increasing internationally, but the role of ATS use as a co‐factor for HIV infection remains unclear. We aimed to summarize the association between ATS use and HIV infection among MSM. Methods We conducted a systematic search of MEDLINE, EMBASE, GLOBAL HEALTH and PsycINFO for relevant English, peer‐reviewed articles of quantitative studies published between 1980 and 25 April 2013. Pooled estimates of the association – prevalence rate ratios (PRR, cross‐sectional studies), odds ratio (OR, case‐control studies) and hazard ratio (HR, longitudinal studies), with 95% Confidence Intervals (CI) – were calculated using random‐effects models stratified by study design and ATS group (meth/amphetamines vs. ecstasy). We assessed the existence of publication bias in funnel plots and checked for sources of heterogeneity using meta‐regression and subgroup analysis. Results We identified 6710 article titles, screened 1716 abstracts and reviewed 267 full text articles. A total of 35 publications were eligible for data abstraction and meta‐analysis, resulting in 56 records of ATS use. Most studies (31/35) were conducted in high‐income countries. Published studies used different research designs, samples and measures of ATS use. The pooled association between meth/amphetamine use and HIV infection was statistically significant in all three designs (PRR=1.86; 95% CI: 1.57–2.17; OR=2.73; 95% CI: 2.16–3.46 and HR=3.43; 95% CI: 2.98–3.95, respectively, for cross‐sectional, case‐control and longitudinal studies). Ecstasy use was not associated with HIV infection in cross‐sectional studies (PRR=1.15; 95% CI: 0.88–1.49; OR=3.04; 95% CI: 1.29–7.18 and HR=2.48; 95% CI: 1.42–4.35, respectively, for cross‐sectional, case‐control and longitudinal studies). Results in cross‐sectional studies were highly heterogeneous due to issues with ATS measurement and different sampling frames. Conclusions While meth/amphetamine use was significantly associated with HIV infection among MSM in high‐income countries in all study designs, evidence of the role of ecstasy in HIV infection was lacking in cross‐sectional studies. Cross‐sectional study design, measurement approaches and source populations may also be important modifiers of the strength and the direction of associations. Event‐specific measure of individual drug is required to establish temporal relationship between ATS use and HIV infection. HIV prevention programmes targeting MSM should consider including interventions designed to address meth/amphetamine use.