You seem to be the "go to" guy on HIV and substance use and I couldn't find anything specific to my question in the forums or elsewhere. About 7 years ago I engaged in IV meth use. This went on for about a year and a half. During that time I became infected. I haven't used since then and am well off the drugs but I can't help but wonder if it did some long term damage. At my lowest, my CD4 was 150 which was right before I went on meds. I've never been able to get higher than about 425 CD4 though I've remained undetectable and adherent. Did my meth use have lasting repercussions? Thanks.

Congratulations on freeing yourself from methamphetamine - that is huge achievement which, as you know, can be a long and difficult struggle. Active meth use exacerbates many complications from HIV, including problems with adherence, neurological concerns, and it can even accelerate replication of HIV. The body slowly repairs most of the damage once one stops using the drug. For example, new neural pathways are formed in the brain, a process that can take up to 24 months (which makes getting clean that much harder). The long-term impact of meth use on CD4 counts is not definitively understood, but any lasting effects after so many years clean appear to be minimal (or at least haven't been documented to my knowledge). Keep up the good work!