Okafor Chukwuemeka N, Yoon Jin H, Jean-Berluche Ducel, Mayes Taryn L, Shoptaw Steve, Trivedi Madhukar H, Potter Jennifer S, Schmitz Joy
Department of Medicine, Division of Infectious Diseases, Long School of Medicine, University of Texas Health Science Center San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78229-3900, USA.
Be Well Institute for Substance Use and Related Disorders, Long School of Medicine, University of Texas Health Science Center San Antonio, San Antonio, San Antonio, TX, USA.
Int J Behav Med. 2025 Apr 7. doi: 10.1007/s12529-025-10364-z.
Methamphetamine (MA) use has been linked to engaging in sexual risk behaviors (SRBs) that are associated with HIV/STIs, particularly among men who have sex with men (MSM) and men who have sex with men and women (MSMW; hereafter MSM/W). The objectives of this analysis were to determine whether reduced MA is associated with decreases in SRBs in a sample of MSM/W.
Data came from the ADAPT- 2 trial, a randomized, double-blind, two-stage sequential parallel design trial evaluating extended-release injectable naltrexone (NTX) and oral bupropion (BUP) vs. placebo for MA use disorder. In the first 6 weeks of the trial (stage 1), participants were randomized to receive NTX-BUP or placebo. In the second 6 weeks, participants in the placebo group who did not have a treatment response were rerandomized (stage 2). For this secondary analysis, the independent variable was the number of MA-negative urine drug screens (UDS). The dependent variables included three different types of SRBs. Regression models of the independent and dependent variables were adjusted for age, race/ethnicity status, marital status, treatment assignment, and baseline SRBs.
Of the 151 participants, median age was 40 years and majority were non-Hispanic white (52%) and completed more than high school education (82%). Each additional MA-negative UDS was associated with a 7% (adjusted rate ratio (aRR) = 0.93; 95% CI, 0.87, 0.99) reduction in total number of sex partners in stage 2 only. Each additional MA-negative UDS was associated with a 13% (aRR = 0.87 95%; confidence interval (CI), (0.76, 0.98)) and 9% (aRR = 0.91; 95% CI, 0.84, 0.99) reduction in number of condomless sexual encounters in stage 1 and stage 2, respectively. Lastly, each additional MA-negative UDS was associated with a 16% (aRR = 0.84; 95% (CI), 0.75, 0.94)) and 27% (aRR = 0.73; 95% CI, 0.64, 0.84) reduction in number of sexual encounters when high on MA.
Our analysis showed that reductions in MA use was associated with reductions in several sexual risk behaviors associated with HIV/STI. These findings provide further support for exploring reductions in sexual risk behaviors as a clinical endpoint in future treatment interventions for MA use.
使用甲基苯丙胺（MA）与参与与艾滋病毒/性传播感染相关的性风险行为（SRB）有关，特别是在男男性行为者（MSM）以及与男性和女性都发生性行为的男性（MSMW，以下简称MSM/W）中。本分析的目的是确定在MSM/W样本中，MA使用量的减少是否与SRB的减少相关。
数据来自ADAPT-2试验，这是一项随机、双盲、两阶段序贯平行设计试验，评估长效注射用纳曲酮（NTX）和口服安非他酮（BUP）与安慰剂治疗MA使用障碍的效果。在试验的前6周（第1阶段），参与者被随机分配接受NTX-BUP或安慰剂。在接下来的6周，未产生治疗反应的安慰剂组参与者被重新随机分组（第2阶段）。对于这项二次分析，自变量是MA阴性尿液药物筛查（UDS）的次数。因变量包括三种不同类型的SRB。对自变量和因变量的回归模型进行了年龄、种族/族裔状况、婚姻状况、治疗分配和基线SRB的校正。
151名参与者的中位年龄为40岁，大多数是非西班牙裔白人（52%），并且完成了高中以上教育（82%）。仅在第2阶段，每增加一次MA阴性UDS，性伴侣总数就减少7%（校正率比（aRR）=0.93；95%置信区间（CI），0.87，0.99）。每增加一次MA阴性UDS，在第1阶段和第2阶段无保护性行为的次数分别减少13%（aRR =0.87；95%置信区间（CI），（0.76，0.98））和9%（aRR =0.91；95% CI，0.84，0.99）。最后，每增加一次MA阴性UDS，在吸食MA时性行为的次数分别减少16%（aRR =0.84；95%（CI），0.75，0.94））和27%（aRR =0.73；95% CI，0.64，0.84）。
我们 的分析表明，MA使用量的减少与几种与艾滋病毒/性传播感染相关的性风险行为的减少有关。这些发现为在未来MA使用的治疗干预中将减少性风险行为作为临床终点进行探索提供了进一步的支持。
