2019 Ryan White HIV/AIDS Program CLINICAL CONFERENCE

Methamphetamines and Dopamine Effects

Motor Task Loss ofdopamine transporters in themeth abusers may result in slowing of motor reactions.

1.0 1.2 1.4 1.6 1.8 2.0

7 8 9 10 11 12 13

Time Gait (seconds)

Normal Control

Bmax/Kd

1.0 1.2 1.4 1.6 1.8 2.0

Memory task Loss ofdopamine transporters in themeth abusers may result inmemory impairment.

Dopamine Transporter

4 6 8 10 12 14 16

Delayed Recall (words remembered)

Volkowetal.,Am. J.Psychiatry,2001. .

Methamphetamine Abuser

Slide31of42FromRDBruce,MD,MA,MS atNewOrleans,LA,December4-7,2019,RyanWhiteHIV/AIDS ProgramCLINICAL CONFERENCE, IAS  USA.

HIV Specific Methamphetamines Effects

▪ Neurocognitive effects and HIV may result in permanent neurobiological changes. ▪ Methamphetamine increases HIV replication and expression of CCR5 on macrophages and these events may contribute to the immunopathogenesis of HIV-infected methamphetamine users. ▪ Reduced neurocognitive performance can severely compromise HIV clinical care and is associated with HIV nonadherence and the development of HIV resistance.

Slide32of42FromRDBruce,MD,MA,MS atNewOrleans,LA,December4-7,2019,RyanWhiteHIV/AIDS ProgramCLINICAL CONFERENCE, IAS  USA.

Treatment

Slide33of42FromRDBruce,MD,MA,MS atNewOrleans,LA,December4-7,2019,RyanWhiteHIV/AIDS ProgramCLINICAL CONFERENCE, IAS  USA. ▫ Motivation Interviewing – motivated to do treatment ▫ Cognitive Behavioral Therapy – getting you to think differently about drug use ▪ Pharmacological Treatment ▫ No pharmacological agents have demonstrated efficacy through Phase 2 trials. Morley, K. C., et al. (2017). "Pharmacotherapeutic agents in the treatment of methamphetamine dependence." Expert Opin Investig Drugs 26 (5): 563-578. ▪ Behavioral Treatment (Therapy)