In the ANRS IPERGAY trial conducted among high risk MSM, 86% relative reduction of HIV-incidence was reported with on demand PrEP use with TDF/FTC. Use of Chemsex drugs is increasingly reported among MSM and is associated with higher risk behavior.
During the ANRS IPERGAY trial, participants (pts) were asked every four month to provide hair samples to detect drugs (except the GHB/GBL for technical reasons). When possible a segmental analysis was carried out, 1 cm corresponding to 1 month of drug use. A total of 86 molecules including conventional substances (cocaine, amphetamines, opiates) and 31 New Psychoactive Substances (NPS) were screened and quantified using Triple Quad TSQ Vantage (ThermoFisher®) in MRM mode.
Sixty nine volunteers were enrolled, among the 429 pts of the Ipergay study population: median [IQR] age 35 years [28;41], number of sexual partners/2 months 9 [5;15], number of sexual intercourse/4 weeks 10 [5;16], similar to the overall IPERGAY population. A total of 219 hair segments (1.5 to 2.5cm length) were analyzed, corresponding each to 1.5 to 2.5 months of consumption. Drugs of abuse were detected in 87% (60/69) pts: 47 pts (68%) were tested positive to Cocaine, 41 (59%) MDMA, 26 (38%) Ketamine, 26 (38%) to one or more NPS, 9 (13%) Codeine, 6 (9%) Methamphetamine, 4 (6%) Amphetamine. The most frequently detected NPS were two cathinones, 14 Mephedrone and 11 4-MEC, followed by 5 ethylphenidate, 4 methylone, 4 methoxetamine, 3 methiopropamine, 3 PMMA, 3 MDPV, 1 metamfepramone, 1 5F-PB22, 1 methylphenidate, 1 diphenidine, 1 phendimetrazine, 1 phentermine, 1 N-methyl-2-AI and 1 dimethylone. No piperazine like TFMPP, α-PVP or m-CPP was found. No case of NPS use alone was found. MSM pts consumed NPS associated to cocaine, MDMA or ketamine in 25/26 (96%), 23/26 (88%), and 18/26 (69%) of cases respectively, showing poly-consumptions. Segmental hair analysis performed in 69% of cases showed wide range exposures, ranging from unique intake (concentration range 5-20 pg/mg) to chronic abuse (> 90 ng/mg for amphetamines) studied. Drugs detection in our study seems more important than the self-reported consumption of recreational drugs in the ANRS IPERGAY trial (44%).
Prevalence of NPS and especially synthetic cathinones use in the MSM PreP population is high but lower than conventional drugs like cocaine and amphetamine, especially MDMA. Hair analysis is the only way to accurately reflect drugs consumption and can improve prevention policies.