Recreational drug use very common among HIV-positive Londoners admitted for inpatient care

Recent 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 visits).”

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.

Investigators from 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.

The HIV-positive 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.

Analysis of 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.”

“A structured 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.”