Drugs and HIV

Alcohol

There is no evidence that moderate drinking (a unit or two a day) does any harm to people with HIV. However, if you have hepatitis or high levels of blood fats, then you may have to stop drinking alcohol altogether or keep consumption down to an absolute minimum.

Heavy drinking can have potentially serious consequences for those taking anti-HIV drugs: it can affect your immune system and slow down recovery from infections, and can damage your liver function. Alcohol is processed by the liver and a healthy liver is important for the body to process medicines effectively. The blood fat increases caused by some anti-HIV drugs can be made worse by heavy drinking.

Alcohol can react badly with certain medicines, so it is a good idea to check with your doctor or pharmacist if it is safe to drink alcohol with any new medicines you are prescribed. However, there are no significant interactions between any of the currently available anti-HIV drugs and alcohol.

Cannabis

The short-term risks of cannabis use include anxiety, panic, and paranoia. Memory and attention can also be affected. If cannabis is smoked, long-term use is known to cause many smoking-related illnesses such as asthma, bronchitis, emphysema and heart disease. This may be of particular concern to people with HIV who have suffered lung damage from TB, or those with increased lipids from anti-HIV therapy.

It is not known how cannabis reacts with anti-HIV drugs. Like any mood-altering drug, cannabis may have an impact on a person's ability to adhere to their medication schedule and those using cannabis, or any other recreational drug, need to develop strategies to help them stick to their medication regime.

Cocaine

Cocaine is not metabolised by the body in the same way as anti-HIV drugs, so there does not appear to be cause for concern about interactions between them. However, some studies have suggested that HIV disease progresses faster in regular cocaine users.

Ecstasy

As ecstasy is an illegal substance there have been no proper clinical trials exploring the risks of using it for people with HIV. The effects of ecstasy on the immune system and HIV disease progression are therefore uncertain.

Certain anti-HIV drugs can react dramatically with ecstasy, particularly ritonavir. As the body uses the same process to break down both ritonavir and ecstasy, ritonavir boosts the amount of ecstasy in the bloodstream by between 200% and 300%, leading to the danger of overdosing. The class of anti-HIV drugs called protease inhibitors are metabolised using a similar process, and there have been hospitalisations due to adverse reactions to ecstasy among those taking this type of medication.

GHB

Levels of GHB may be increased to life-threatening levels if taken alongside a protease inhibitor, according to a case report from the US. As GHB can be slipped into a drink and used to aid �date-rape�, those taking protease inhibitors should be especially aware of this danger.

Ketamine

There are no recorded interactions between ketamine and the currently available anti-HIV drugs. However, use of ketamine can impact negatively on sexual behaviour and adhering to a medication regime.

Methamphetamine

Anecdotal evidence suggests that methamphetamine use causes faster HIV disease progression. Rapid falls in CD4 cell counts have been observed in methamphetamine users, but it is uncertain what influence other related factors, such as difficulty sleeping or eating, may have on this.

As the body processes them using the same mechanism, the protease inhibitor ritonavir increases levels of methamphetamine to possibly dangerous levels.

Poppers

The long-term effects of poppers have been a matter of considerable controversy, particular as it has been argued that they cause AIDS. However, this view is not supported by any scientific evidence. Some animal studies have shown that poppers can suppress immune responses and have cancer-causing effects.

There are no documented interactions between anti-HIV drugs and poppers. However, inhaling poppers after taking Viagra can result in a potentially dangerous, even fatal, drop in blood pressure. This danger is increased if a person is taking a protease inhibitor as part of their therapy.

Tobacco

Smoking in itself does not make HIV infection worse. The rate at which HIV disease progresses, or the number of CD4 cells lost, is no greater in smokers than non-smokers. Anti-HIV medication is just as effective in smokers as non-smokers.

However, there is good evidence that people with HIV who smoke are more likely to get certain infections and AIDS-defining illnesses, particularly those affecting the chest. As well as the risks of smoking in terms of lung cancer and heart disease, HIV+ smokers are more likely to develop pneumonia, oral thrush, and emphysema.

For sources of local help with giving up smoking visit www.givingupsmoking.co.uk.

For more information about HIV and AIDS, click here.