MIX AND MASH
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Do party drugs like ‘E’ and coke weaken HIV meds and harm the immune system? Susan Cole reports
We’ve all ‘used’ at some time. Perhaps it was legal: caffeine, fags or drink, or maybe it was one of those drugs on the other side law like ecstasy, cannabis or cocaine.
Whatever your tipple, there’s little doubt recreational drug use is growing in the UK with most users insisting it’s not a problem or a serious risk to health. But can HIV positive people partial to pill popping or snorting be quite so confident?
When London clubber Philip K died in 1996, an autopsy found high levels of ecstasy in his blood which may have been caused by ritonavir, the protease inhibitor. His death prompted many questions: did drugs weaken the immune system, hasten progression of HIV, interfere with antiretroviral therapy or cause serious side effects? And were people living with HIV who used recreationals more likely to forget to take their meds or have unprotected sex?
There is little research on how party drugs interact with HIV meds as most drug companies shy away from any association with illegal drug use. So most guidelines are based on what is known about how certain drugs are cleared by the body.
Effects: Amphetamine-based pill widely used on the club scene; enhances mood, energy levels and feelings of empathy. Has unpredictable effects depending on ingredients.
Downside: Unpleasant short and long-term effects include feeling sick, breathless and paranoid. E raises body temperature and can easily lead to dehydration.
Interactions: Protease inhibitors, particularly ritonavir, may cause a three to 10 fold increase in ecstasy levels in the bloodstream, leading to overdose. Interaction between NNRTIs and Ecstasy is largely unknown, but nevirapine has the opposite metabolic effect to ritonavir, resulting in lower than usual blood levels of some drugs.
Tip: Drink plenty of fluids throughout the night, particularly if dancing, to avoid dehydration. Take frequent breaks to cool off. Ideally avoid using with other drugs, particularly alcohol.
Effects: Stimulant that makes you feel euphoric and confident for 15 to 30 minutes followed by a ‘come down’. Repeated use over a few hours can lead to paranoia and anxiety.
Downside: Repeated sniffing damages the nose membrane and can lead to overdose, which can cause heart attack and strokes, particularly for people who ‘bang up’ or inject.
Interactions: One test-tube study suggests coke may cause HIV to reproduce 20 times faster than normal, but as yet no definitive link has been found between cocaine use and viral load in humans.
Effects: Relaxes the nervous system, disinhibits and makes you talkative and sociable.
Downside: Increased use can cause short-term nausea, disorientatation and mental confusion. Long term sustained use can damage liver and kidneys and can even kill.
Interactions: No evidence of direct interaction with anti-HIV meds but chronic use may increase risk of drug toxicities like liver damage and neuropathy. Excessive boozing has been linked to poor adherence.
Tip: Men with healthy livers should drink no more than four units a day. Moderate drinking throughout with a break week does less harm than bingeing. Booze can be dangerous if taken with other drugs, particularly GHB and sedatives.
Effects: Liquid sedative anaesthetic. Makes you sleepy and gives sense of well being and can make you horny.
Downside: In larger doses disorientation, fits, coma breathing difficulties, and even death have been reported, particularly when mixed with alcohol.
Interactions: Potentially dangerous when mixed with protease inhibitors like ritonavir and saquinavir, which affect how the liver deals with substances.
Tip: Avoid alcohol. Effects last for up to 24 hours, so think ahead. If unconscious, users should not be left alone in case of choking on vomit or their own tongue.
Effects: Powerful anaesthetic with pain killing and ‘trippy’ effects. Can cause ‘out of body experiences’ for up to three hours.
Downside: Negative effects include temporary paralysis, scary hallucinations and memory loss.
Interactions: Anti-HIV meds, particularly PIs, may increase level of K in the bloodstream, leading to increased heart rate, increased blood pressure or difficulty breathing.
Tip: Excess doses have killed. Do not leave users alone if feeling sick, in case of loss of consciousness and choking on vomit. Avoid alcohol, GHB and other sedatives.
Effects: Amphetamine that makes you feel alert, awake, energetic and talkative. Crystal Methamphetamine is a strong, pure speed, with more intense effects.
Downside: Anxiety and paranoia common. Can lead to dehydration, palpitations, breathlessness, chest pain or heart attack. Long term can lead to weight loss, lack of sleep and fatigue and possible immunosuppression.
Inteactions: There is a theoretical concern that PIs, particularly ritonavir, can decrease clearance of crystal resulting in a two-three fold build-up in the blood, possibly leading to overdose.
Tip: If injecting, use a clean and safe technique. Avoid mixing with other drugs. Start with lower doses of crystal to take account of possible enhanced activity by protease inhibitors.
Worried about drugs and want to talk to someone? National Drugs Helpline 0800 77 66 00 24Mainliners (for intravenous drug users) 020 7582 5226Narcotics Anonymous 020 7730 0009The Hungerford Project 020 7437 3523 |
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Richard, 31, HIV positive for five years: “I usually take drugs every weekend. I don’t think it has affected my health, but it affects my energy levels and mental health. It’s hard to remember to take medication sometimes. Drugs allow me to do things I want to do sexually, but GHB and ketamine make me lose a sense of reality, and I’m more likely to have unprotected sex. I take vitamins and an electrolyte formula after a heavy weekend and I always take my meds with me when I go out and set an alarm as a reminder.’
Amy*, 33, positive for six years: “I occasionally snort coke, but go for it when I do. A couple of years ago, I was taking it every weekend, as well as one night during the week. My CD4 count dropped dramatically, from about 300 to 150 in less than a month. I still wonder if it was due to the amount of coke I was doing or because I was always exhausted from lack of sleep and poor diet. I never mix alcohol with coke, as I do more of both, and end up feeling terrible the next day. I try to drink lots of water and usually take vitamin C tablets. I’ve never forgotten to take my medication, although I may take it a little late, but that could happen whenever I go out, regardless of drugs and alcohol.
Mike*, 37, positive for 11 years: “I only use coke about three or four times a year. I had ketamine once but it made me go bloody loony. Coke gives me an ‘up’ and helps me enjoy myself a little bit longer. I don’t do Es because I’ve seen friends completely lose control on it. I don’t do drugs often because I can’t afford them, not because of the health risks. They make you lose a sense of protecting yourself and the other person during sex. I’ve had more unprotected sex when taking drugs. They’re overrated and must have an affect on your HIV if you take too much.
Sam*, 42, positive for six years: “I only do E and K. Since becoming positive I’ve become more risk taking and less averse. To me, long term damage doesn’t seem particularly important. I’ve never had an adverse reaction from mixing drugs with my meds. I don’t drink or smoke, I think they’re worse. I’m probably more likely to have unprotected sex if I take drugs because I’m more uninhibited. I feel more run down after a weekend of drugs, but that could be from not sleeping enough.
* names have been changed
