A behavioral intervention reduced the HIV viral load in men who have sex with men and use methamphetamine, according to a groundbreaking University of Miami Miller School of Medicine study. “For the first time, we found that a behavioral intervention can achieve durable and clinically meaningful reductions in HIV viral load in people who use substances,” said Adam W. Carrico, Ph.D., associate professor of public health sciences. “The findings are an important step forward as we look to optimize health outcomes and reduce risk of HIV transmission in this high-priority population.”
Dr. Carrico was the lead author of the study, “Randomized Controlled Trial of a Positive Affect Intervention to Reduce HIV Viral Load in Methamphetamine-Using Sexual Minority Men,” presented as a late-breaking abstract at the 2019 International AIDS Society Conference in July in Mexico City. Daniel J. Feaster, Ph.D., associate professor in the Biostatistics Division of public health sciences, was a co-author on the collaborative study, which was conducted with several other academic institutions and the San Francisco AIDS Foundation.
From 2013 to 2017, the randomized controlled trial enrolled 110 HIV-positive men who have sex with men who had a recent history of methamphetamine use. The majority of participants were racial or ethnic minorities. All participants received contingency management, an evidence-based approach that provides financial incentives for stimulant abstinence, at the San Francisco AIDS Foundation for three months.
Half of participants were randomized to receive a five-session counseling intervention called Affect Regulation Treatment to Enhance Methamphetamine Intervention Success (ARTEMIS). The ARTEMIS counseling sessions included mindfulness and meditation practices, along with skills for building positive emotions, such as a sense of gratitude. The control group took part in five individual sessions that included assessments and identical incentives.
Dr. Carrico’s team found that the men who were randomized to receive the ARTEMIS sessions had significantly lower viral load at six, 12, and 15 months. These men were also substantially less likely to have an unsuppressed HIV viral load of 200 copies or more over the 15 months, an important outcome because this is the level at which HIV can be transmitted to uninfected sexual partners. Finally, men randomized to receive ARTEMIS reported more positive emotions such as happiness and gratitude, and reduced cravings for methamphetamine or other stimulants.
“One of the major problems for people who struggle with substance use disorders is that other things in life lose their pleasure,” said Dr. Carrico. “Our study helped men build positive emotions into their lives, so that substance use becomes less of a dominant focus.”
Dr. Carrico noted men who have sex with men have a high rate of methamphetamine use. Other research from his team and others also demonstrates that stimulant use has a negative impact on the immune system in HIV-positive men, and hinders adherence to antiviral medications.
“A behavioral intervention can help men who use meth to manage their viral load more effectively, and reduce the risk of their transmitting HIV to others,” he said. “While this approach requires a commitment of public health resources, behavioral interventions could have a similar positive impact in South Florida and other epicenters of the HIV epidemic.”