How Does Recreational Drug Use Affect HIV?

Recreational drug use increases a person’s chances of becoming infected with HIV. Also, for people taking antiretroviral drugs (ARV) to fight HIV, there can be serious interactions between drugs and ARV medications. These interactions can result in an inadequate dose or an overdose of ARV or recreational drugs. Some of these interactions may be fatal.

Using alcohol or drugs before or during sexual activity greatly increases the chances of not practicing safer sex guidelines. You may have more fun when using drugs but you are also more likely to have sex. If you do, it is likely that you will not think about safer sex guidelines to reduce the odds of getting HIV or another sexually transmitted disease. If you swap drugs for sex, the risk increases even more.

If you are feeling the effects of using drugs, you may ask yourself if you have been infected with HIV. Some of the signs and symptoms are superimposed. Make sure your doctor knows about all the reasons why you may be feeling bad.

Drug Use and HIV Disease

There is very little research into drug use and HIV disease progression. However, it is clear that if you use drugs frequently, you are likely not to pay attention to your physical health. Sleeping enough and eating regularly may help you stay healthy. Drug use can cause you to not sleep or can reduce your appetite. If this happens, your body and immune system may be weakened. This may mean that you feel the side effects of ARVs or that you get infections that take advantage of your weakened immune system (opportunistic infections).

A serious risk for people with HIV who use drugs is that they may miss doses of their ARV medications. This can lead to resistance development where HIV changes (mutates) and the ARV drugs you are taking stop working.

Interactions and Drugs

Another major risk for people with HIV who use drugs is that the drugs may interact with the ARVs. These interactions can increase or decrease the levels of ARVs or recreational drugs. In the worst cases, the ARVs may stop working because there are not enough medications in the body. Also, the drug interactions can cause serious, possibly fatal increases in the levels of recreational drugs.

There is practically no research on interactions between ARVs and recreational drugs. Recreational drug use is illegal and pharmaceutical companies cannot provide drugs to people with HIV, not even to study their effects. This means that information on interactions between drugs and ARVs is based on laboratory studies of recreational drug or on what is already known about drug processing (metabolism) in the body.

Most ARVs are processed in the liver. All protease inhibitors use this route. The level of recreational drugs metabolized in the liver may change significantly.

Alcohol

Alcohol can increase blood levels of abacavir (Ziagen®) and amprenavir (Agenerase®). Chronic alcohol use can decrease the levels of many ARVs. It may increase the risk of developing pancreatitis when used together with didanosine (ddI, Videx®).

Cocaine

Interactions between cocaine and ARVs is practically theoretical and they are very unlikely to increase cocaine toxicity.

Crystal meth, methamphetamine (also known as crack, glass, Tina and many other names)

This drug uses the same hepatic route as protease inhibitors. There are increased chances of suffering serious interactions. When used with ritonavir (Norvir®), amphetamine levels increase 2 or 3 times.

Ecstasy/MDMA

Ecstasy uses the same hepatic route as protease inhibitors. This can cause very high levels of ecstasy in the body of people who are taking protease inhibitors. There is one reported case of death due to the interaction between ecstasy and ritonavir. It can also increase the chances of developing kidney stones with indinavir (Crixivan®) due to dehydration.

GHB (Xyrem®, "date rape drug")

This is generally eliminated from the body by the lungs (through breathing). However, protease inhibitors may increase GHB levels. Interactions with non-nucleoside reverse transcriptase inhibitors (delavirdine, Rescriptor®; nevirapine, Viramune® and efavirenz, Sustiva®) are unknown.

Ketamine (K, Special K)

This drug is primarily metabolized in the liver. There are no reports or studies of interactions with ARVs. However, it is possible that ritonavir (Norvir®), nelfinavir (Viracept®) and efavirenz (Sustiva®) cause high levels of ketamine. This could cause hepatitis.

LSD

The metabolism of LSD is not well understood. Interactions with ARVs are possible but unknown.

Marihuana

There are no known interactions between marihuana and ARVs. In theory, it is believed that interactions would be greater if marihuana were eaten instead of smoked.

In Short

Many recreational drugs interact with ARVs. Information on interactions is incomplete or hard to find. Interactions may be dangerous or fatal.

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