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Hair Testing to Detect Long-term Methamphetamine Use in People Living with and without HIV.

Ayesha Appa1, Marjan Javanbakht2, Matthew Spinelli1

  • 1Division of HIV, ID and Global Medicine, University of California San Francisco; San Francisco, California, USA.

Journal of Acquired Immune Deficiency Syndromes (1999)
|June 22, 2026
PubMed
Summary

Hair testing effectively detects methamphetamine (MA) use missed by urine tests, offering a reliable method for substance use research. This validated biomarker aids in understanding longer-term MA use patterns in individuals at risk for or living with HIV.

Keywords:
Virologic suppressionbiomarkershair testingmethamphetamine usepeople living with HIVsubstance use detection

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Area of Science:

  • Clinical Research
  • Toxicology
  • Public Health

Background:

  • The United States is experiencing a significant rise in methamphetamine (MA) use.
  • This surge disproportionately affects people living with HIV (PWH) or at risk of HIV acquisition.
  • Existing MA detection methods like self-report and urine tests have limitations in capturing longer-term use.

Purpose of the Study:

  • To validate hair testing as a method for detecting longer-term MA use in a clinical research setting.
  • To compare the efficacy of hair testing against urine testing and self-reporting.
  • To assess the association between MA use and virologic suppression in people living with HIV.

Main Methods:

  • A cross-sectional validation study was conducted using data from the mSTUDY cohort in Los Angeles.
  • Hair samples were analyzed from individuals reporting regular MA use (n=22) and controls (n=22), all with negative urine MA tests.
  • Liquid chromatography-tandem mass spectrometry was used for hair analysis, with MA positivity defined as >200 pg/mg.

Main Results:

  • Hair testing identified MA use in 77% of individuals reporting regular use, despite negative urine tests.
  • The method demonstrated a positive likelihood ratio of 6.0 for detecting MA use missed by urine tests.
  • Among people living with HIV (PWH), MA use was associated with lower rates of virologic suppression (45% vs. 82%).

Conclusions:

  • Hair testing is a validated and effective biomarker for identifying longer-term MA use.
  • It offers superior detection compared to urine testing for capturing MA use patterns.
  • This method is crucial for advancing substance use and HIV research by providing objective data.