Recreational drugs and HIV

Question:

I sometimes like to party, and I have used a number of different drugs. How could this affect my health and my HIV treatment?

The essentials:

Most interactions between recreational drugs and HIV medications have not been scientifically studied, nor are they likely to be, given that most are illegal substances. However, people have shown through experience that “safer partying” is possible, and there are some specific tips that can help make drug use safer and healthier.

More details:

Many recreational drugs are psychologically or physically addictive. Drug use can be enjoyable as long as it doesn’t interfere with health or finances. Excessive drug use may lead to poor nutrition and/or health maintenance.

Drug interactions:

Many recreational drugs may be dangerous when combined with HIV medications, based on individual case reports, and what we know about how the body processes these drugs. Actual risk assessments of individual situations are hard to make. Caution is necessary if you are taking any of the HIV drugs known as “protease inhibitors” (PIs), since these often affect the levels of other drugs in the bloodstream and body. If you take recreational drugs while you also taking a protease inhibitor, you may end up with more than you expected.

Some specific drug interactions that we know about include:

  • Ecstasy and crystal meth (“Tina”) may reach dangerously high levels in the blood in combination with a PI such as ritonavir (Norvir). They may also cause lasting damage to important chemicals in the brain, leaving users vulnerable to conditions such as untreatable depression.
  • Viagra in high doses in combination with PIs may cause serious heart problems. It is also dangerous to combine Viagra (or similar drugs like Cialis and Levitra) with poppers, because this can put a severe strain on the heart.
  • Some anti-HIV drugs such as nevirapine (Viramune) and efavirenz (Sustiva) may lower blood levels of heroin or methadone in the body, possibly causing involuntary withdrawal. Some other drugs may raise blood levels of these recreational drugs, which may cause a dangerous overdose.

Needle use:

Sharing needles or “works” (drug-injecting equipment) for injecting may expose other people to HIV, and expose you to other strains of HIV and other serious infections such as hepatitis C. You can get blood poisoning from used or dirty needles. Find out if there’s a needle exchange in your area so you can use clean new needles every time you inject.

Other drugs:

  • Cocaine may have relatively few potential drug interactions with anti-HIV drugs, but it may make immune cells more vulnerable to HIV. This could make HIV disease progress faster.
  • Alcohol may damage the liver and pancreas. Used excessively, it can lead to cirrhosis of the liver, liver cancer, and pancreatitis. Heavy use could also affect the way the body uses antiretroviral medications, which could interfere with the success of your HIV treatment.
  • Inhaled drugs such as marijuana may cause respiratory trouble and risk of developing lung and other cancers. Chronic marijuana use may also impair short-term memory and motivation, causing adherence problems. (However, marijuana may be useful to stimulate the appetite and control nausea.)

In general, if your judgment is impaired by recreational drugs, you may take risks (sexual or otherwise) that you wouldn’t normally take, leading to sexually transmitted infections or other problems. It’s important to try to “party and play” safely. Some of the resources listed below can be useful if you need help.

Key terms to know:

adherence – Taking medications as prescribed, without missing doses or taking them incorrectly. (The word “compliance” is also, less frequently, used.)
antiretroviral – A medication that fights HIV.
ART – Antiretroviral therapy; a combination of antiretrovirals carefully chosen to be as effective as possible.

More information:

Some useful resources from other websites:

Drug interactions tables:

Published: 2015