HIV Infections, Substance Abuse
Conditions
Keywords
Methamphetamine, HIV
Brief summary
Studies demonstrate that methamphetamine (meth) use is associated with high-risk sexual behavior among MSM, putting meth-using MSM at extraordinarily high risk for transmitting or acquiring HIV. No studies have tested the feasibility and acceptability of conducting pharmacologic interventions to reduce meth use and meth-associated sexual risk behavior among MSM. The purpose of this pilot study is to determine the feasibility enrolling and retaining meth-dependent MSM into a pharmacologic study of bupropion vs. placebo and measuring the tolerability of and adherence to medication among these participants.
Detailed description
The high rate of meth use among MSM is paralleled by evidence of rises in sexual risk behavior and HIV infection among this population. The MSM meth epidemic, and its link with HIV transmission, underscores the need to pilot test new, innovative modalities to reduce meth use and meth-associated sexual risk behavior. Ultimately, a pharmacologic treatment for meth use may not only serve to improve outcomes among those who are accessing current treatment services, but might also benefit those who are not willing or able to utilize such services. While studies show that MSM who enter substance use treatment decrease both their substance use and sexual risk behavior, current behavioral meth treatment programs report low rates of success in treating meth dependence among MSM. We believe the time has come to test the acceptability of pharmacologic interventions to reduce meth use among MSM, and to assess the feasibility of conducting such trials among sexually active, meth-dependent MSM, whose meth-associated sexual behavior use places them at extraordinarily high risk for transmitting or acquiring HIV. In this pilot study, we will provide meth-dependent MSM with placebo or daily bupropion XL (extended-release), a well-tolerated dopamine agonist that has potential to reduce meth use. The specific aims of this study are: 1. To assess the feasibility of enrolling and retaining meth-dependent MSM into a randomized, double-blind study of bupropion versus placebo with biologic (urine meth testing) and behavioral (sexual risk) measures. 2. To explore the tolerability of bupropion and placebo among meth-dependent MSM, as determined by the number of adverse clinical events in the bupropion and placebo arms. 3. To describe the acceptability of bupropion and placebo among meth-dependent MSM, by measuring (via electronic pill caps) medication adherence to bupropion and placebo. This randomized, double-blind, placebo-controlled, two-arm pilot study will enroll 30 meth-dependent MSM assigned to receive 3 months of bupropion XL 300 mg daily or placebo. We will include both HIV- and HIV-INFECTED MSM, because meth use is common in both groups. We will enroll meth-dependent MSM because they are the most likely population to benefit from this potential treatment. Participants will be seen weekly for urine specimen collection and substance-use counseling. Clinical exams, medical history, specimen collection, and behavioral assessments will be performed at baseline and at the 1, 2, and 3 month visits. Interim visits will be scheduled whenever indicated by signs or symptoms. Our decision to maintain participants on 3 months of bupropion is based on the smoking literature, which demonstrated bupropion's efficacy in treating nicotine addiction within similar time periods; we anticipate that any future efficacy trial will maintain participants on bupropion for this duration.
Interventions
DRUGBupropion
DRUGPlacebo
Sponsors
National Institute on Drug Abuse (NIDA)
Public Health Foundation Enterprises, Inc.
San Francisco Department of Public Health
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
QUADRUPLE (Subject, Caregiver, Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
MALE
Age
18 Years to 60 Years
Healthy volunteers
Yes
Inclusion criteria
* HIV-negative by rapid test or able to document HIV infection through healthcare provider's note or documentation of laboratory test; * Reports anal sex with men in prior 3 months while using meth * Diagnosed with meth dependence as determined by SCID * Interested in stopping or reducing meth use * Meth-positive urine on screening * No known allergies to bupropion * No current acute illnesses * Able and willing to provide informed consent and to be followed over a 3-month period * Baseline CBC and electrolytes within institutional limits.
Exclusion criteria
* History of seizure * High risk for seizure, including: recent (last 24 months) head trauma, brain injury or surgery; using theophylline or systemic steroids; prior or current history of anorexia or bulimia; prior or current history of alcohol withdrawal symptoms * Measured moderate or severe liver disease (LFTs \> 3 times normal) or history of chronic liver disease * Impaired renal function (creatinine clearance \< 90 ml/min) * Evidence of current major depression, as determined by SCID * Taking anti-depressant medication within last 30 days * Currently on any bupropion-containing regimen * Currently using or unwilling not to use pseudoephedrine-containing products (causes false + urines for meth use) for trial duration * Currently taking antiretroviral therapy (ART) * CD4 count \< 200 cells/mm3 * Any condition that, in the principal investigator's judgment, interferes with safe study participation.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Feasibility: Proportion of Persons Screened Who Are Eligible and Enrolled | At Enrollment | — |
| Feasibility: Proportion of Scheduled Study Visits Completed | 12 weeks | — |
| Feasibility: Proportion of Urine Samples Collected | 12 weeks | — |
| Feasibility: Participants Who Completed the Trial | 12 weeks | — |
| Tolerability: Comparison of Adverse Events in the Bupropion and Placebo Arms. | throughout study | — |
| Acceptability: Adherence to Daily Bupropion and Placebo, as Determined by MEMS (Medication Event Monitoring System) Caps Openings | 12 weeks | Proportion of days in which the MEMS cap device was opened during of the 12 weeks on study drug. |
| Acceptability: Adherence to Daily Bupropion and Placebo, as Determined by Self-report | 12 weeks | Proportional of reported days taking study drug during the 12 weeks of study. |
| Acceptability: Proportion of Participants Discontinuing Medication in Both Arms | 12 weeks | Proportion of participants who discontinued study medication for at least one week prior to study completion. |
Countries
United States
Participant flow
Recruitment details
Participants were actively recruited at the municipal STD and HIV clinics, and by street outreach. Recruitment flyers were posted at locations of active recruitment, in local newspapers and in print media and on social networking websites.
Pre-assignment details
After informed consent, participants were screened in two screening visits, with lab and HIV testing, medical history and physical exam, and urine meth testing.
Participants by arm
| Arm | Count |
|---|---|
| Bupropion Bupropion XL 300mg daily | 20 |
| Placebo Placebo 300mg daily | 10 |
| Total | 30 |
Baseline characteristics
| Characteristic | Bupropion | Placebo | Total |
|---|---|---|---|
| Age, Categorical <=18 years | 0 Participants | 0 Participants | 0 Participants |
| Age, Categorical >=65 years | 0 Participants | 0 Participants | 0 Participants |
| Age, Categorical Between 18 and 65 years | 20 Participants | 10 Participants | 30 Participants |
| Sex: Female, Male Female | 0 Participants | 0 Participants | 0 Participants |
| Sex: Female, Male Male | 20 Participants | 10 Participants | 30 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | — / — | — / — |
| other Total, other adverse events | 17 / 20 | 6 / 10 |
| serious Total, serious adverse events | 0 / 20 | 0 / 10 |
Outcome results
Primary
Acceptability: Adherence to Daily Bupropion and Placebo, as Determined by MEMS (Medication Event Monitoring System) Caps Openings
Proportion of days in which the MEMS cap device was opened during of the 12 weeks on study drug.
Time frame: 12 weeks
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Persons Screened | Acceptability: Adherence to Daily Bupropion and Placebo, as Determined by MEMS (Medication Event Monitoring System) Caps Openings | 59 percentage adherence by MEMS |
| Placebo | Acceptability: Adherence to Daily Bupropion and Placebo, as Determined by MEMS (Medication Event Monitoring System) Caps Openings | 62 percentage adherence by MEMS |
p-value: 0.98Wilcoxon (Mann-Whitney)
Primary
Acceptability: Adherence to Daily Bupropion and Placebo, as Determined by Self-report
Proportional of reported days taking study drug during the 12 weeks of study.
Time frame: 12 weeks
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Persons Screened | Acceptability: Adherence to Daily Bupropion and Placebo, as Determined by Self-report | 85 percentage of self-reported adherence |
| Placebo | Acceptability: Adherence to Daily Bupropion and Placebo, as Determined by Self-report | 75 percentage of self-reported adherence |
Primary
Acceptability: Proportion of Participants Discontinuing Medication in Both Arms
Proportion of participants who discontinued study medication for at least one week prior to study completion.
Time frame: 12 weeks
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Persons Screened | Acceptability: Proportion of Participants Discontinuing Medication in Both Arms | 15 percentage of discontinuations |
| Placebo | Acceptability: Proportion of Participants Discontinuing Medication in Both Arms | 30 percentage of discontinuations |
Primary
Feasibility: Participants Who Completed the Trial
Time frame: 12 weeks
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Persons Screened | Feasibility: Participants Who Completed the Trial | 18 participants who completed the trial |
| Placebo | Feasibility: Participants Who Completed the Trial | 9 participants who completed the trial |
Primary
Feasibility: Proportion of Persons Screened Who Are Eligible and Enrolled
Time frame: At Enrollment
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Persons Screened | Feasibility: Proportion of Persons Screened Who Are Eligible and Enrolled | 30 Eligible persons screened who enrolled |
Primary
Feasibility: Proportion of Scheduled Study Visits Completed
Time frame: 12 weeks
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Persons Screened | Feasibility: Proportion of Scheduled Study Visits Completed | 185 Scheduled study visits completed |
| Placebo | Feasibility: Proportion of Scheduled Study Visits Completed | 96 Scheduled study visits completed |
Primary
Feasibility: Proportion of Urine Samples Collected
Time frame: 12 weeks
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Persons Screened | Feasibility: Proportion of Urine Samples Collected | 193 Urine samples collected |
| Placebo | Feasibility: Proportion of Urine Samples Collected | 97 Urine samples collected |
Primary
Tolerability: Comparison of Adverse Events in the Bupropion and Placebo Arms.
Time frame: throughout study
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Persons Screened | Tolerability: Comparison of Adverse Events in the Bupropion and Placebo Arms. | 40 number of adverse events |
| Placebo | Tolerability: Comparison of Adverse Events in the Bupropion and Placebo Arms. | 11 number of adverse events |