Methamphetamine Use and HIV as Risk Factors for COVID-19

Among men who have sex with men (MSM), there is a resurgent epidemic of methamphetamine (meth)and other stimulant use that fuels new HIV infections and compromises the benefits of HIV treatment asprevention. Although MSM living with HIV who use meth can achieve viral suppression, prior research from ourteam and others has documented that recent stimulant use amplifies immune dysregulation in treated HIVinfection. MSM living with HIV are also more likely to report amplified behavioral risk such as condomless analintercourse that increases risk for HIV acquisition and onward HIV transmission. The scientific premise of thisadministrative supplement is that co-occurring meth and HIV will create a double jeopardy for the novelcoronavirus (COVID-19) pandemic. In order to examine the potentially synergistic effects of meth and HIV forthe COVID-19 pandemic, we will enroll 200 MSM in a seroprevalence study testing for IgM and IgG antibodiesto the novel coronavirus (SARS-CoV-2). Using an intact groups design, participants will be enrolled based onmeth use (user versus non-user) by HIV status (positive versus negative). Among men living with HIV, onlythose who report an undetectable viral load will be enrolled. Among men who are HIV-negative, only those whoare not currently taking pre-exposure prophylaxis (PrEP) will be enrolled. There will be 50 participants enrolledper group: METH+HIV+, METH+HIV-, METH-HIV+, and METH-HIV-. The primary hypothesis is that thosewith co-occurring meth use and HIV (METH+HIV+) will display the greatest seroprevalence of SARS-CoV-2relative to meth or HIV alone (METH+HIV- or METH-HIV+) or controls (METH-HIV-). We will also examine theextent to which co-occurring meth and HIV are indirectly linked to higher SARS-CoV-2 seroprevalence viaalterations in gut-immune dysregulation, smoking behaviors, and decreased adherence to social distancingguidelines. This supplement will provide some of the first data regarding whether and how those with co-occurring meth use and HIV are more vulnerable to SARS-CoV-2 infection. This represents a crucial first stepto identifying high priority populations that will directly inform the development bio-behavioral interventions tomitigate risk for COVID-19. These findings will also inform targeted public health efforts to "flatten thecurve" of community-level SARS-CoV-2 transmission in this rapidly evolving COVID-19 pandemic.