Psychostimulant Abuse and HIV Infection: Cocaine, Methamphetamine, and ‘Bath Salts’ Cathinone Analogs

Abstract

Psychostimulants are among the most widely-abused substances worldwide, and typically exert their abuse-related effects via interactions with monoamine reuptake transporters within the central nervous system. Over the last decade, a symbiotic relationship between psychostimulant abuse and HIV infection has been demonstrated, where psychostimulants potentiate the effects of HIV infection, and HIV infection increases sensitivity to psychostimulant drugs. Most recently, a new class of designer psychostimulants has emerged in abuse-ready ‘bath salt’ preparations. These commercial products typically contain ring-substituted and/or side-chain-substituted analogs of cathinone, which is itself a psychostimulant drug of abuse in its natural plant form. The cathinone analogs exhibit a range of interactions with monoamine transporters, from cocaine-like reuptake inhibition to methamphetamine-like release. Since the primary mechanism of action of these novel drugs overlaps with those of traditional psychostimulants, it may be the case that the cathinone analogs also interact with HIV infection. As use of these emerging cathinone-derived drugs continues to rise, there is an urgent need to better understand the pharmacology and toxicology of these novel compounds, both in terms of their abuse-related effects and in terms of their capacity to interact with HIV infection.