recreational drug use is highly prevalent among HIV-positive people admitted
to inpatient care at the Chelsea and Westminster Hospital, London,
investigators report in HIV Medicine.
Overall, 40% of HIV-positive people newly admitted for inpatient care
reported recent drug use, and a fifth had a positive urine toxicology result. Half
of those reporting use of recreational drugs said they’d used drugs for sexual
enhancement, or chemsex. The investigators suggest that formally screening
HIV-positive people for recreational drug use at the time of admission as
inpatients would provide an opportunity to connect users with drug and
harm reduction services.
“Our data suggest
that in-patient screening is crucial,” write the authors. “Hospital admission
offers a unique opportunity for intervention in hard to reach groups. Most hospital
admissions are not planned, which arguably further increases the chances of
detecting drug use (as opposed to routine screening during planned out-patient
There are a wealth
of data obtained from out-patient sources testifying to high rates of
recreational drug use among HIV-positive individuals in the UK, especially gay
and other men who have sex with men (MSM). However, little is known about the
prevalence and correlates of drug use among HIV-positive people being
admitted to hospital for inpatient care.
the Chelsea and Westminster Hospital therefore designed a study with three
aims: to establish the prevalence of self-reported recent recreational drug use
among HIV-positive people newly admitted for inpatient care; prevalence of
drug use as determined by urine toxicology screening; and to compare the
prevalence and type of drug use between HIV-positive people and a control
group of general medical admissions.
The study took
place between late 2014 and early 2015. The population consisted of 59
HIV-positive people and 48 controls. At the time of admission, a doctor asked
each individual about lifetime and current recreational drug use. Urine samples
were tested for cannabis, morphine, methadone, amphetamines and cocaine.
people were more likely than general medical admissions to be male (84% vs
35%), gay/MSM (71% vs 6%) and younger (median age 47 vs 70 years).
A history of
recreational drug use was reported by 70% of HIV-positive people compared to 29%
of controls. People with HIV were also more likely than general medical
patients to report current recreational drug use (41% vs 10%, respectively),
to have a positive urine toxicology screen (19% vs 2%, respectively) and to
have a drug-related admission to hospital (15% vs 0%, respectively).
Of the 26
HIV-positive people reporting recent drug use, half reported chemsex and
nine reported injecting drug use. Only a quarter of HIV-positive recreational
drug users were known to drug services.
None of the
controls had a history of viral hepatitis. However, 22% of the HIV-positive people had a
history of hepatitis C virus infection and a third had current/past infection
with hepatitis B virus.
HIV-positive people showed that recreational drug users were less likely to
be on antiretroviral therapy than non-users (70% vs 87%) and had poorer adherence when on therapy
(67% vs 76%).
“This is the first
published report describing recreational drug use among HIV-infected
in-patients,” write the authors. “These data are important, as the UK has seen
growing and changing trends in substance misuse and its consequences among
people living with HIV in the last 10 years.”
approach to identifying recreational drug use among HIV-infected in-patients is
highly recommended,” conclude the researchers. “We recommend that
multidisciplinary clinicians routinely and systematically enquire about
recreational drug use on admission of HIV-infected in-patients, through a
tailored pro-forma, for instance.”