Questions and Answers with NAM Keith Alcorn, senior editor and Edwin J Bernard, editor ATU
My doctor told me to be careful when taking recreational drugs since I started taking combination therapy, but surely the occasional ‘e’ doesn’t hurt?
In 1996, a man who had recently started taking a combination of anti-HIV drugs, including the protease inhibitor ritonavir (Norvir), died after taking two and a half ecstasy tablets. An autopsy found unusually high amount of ecstasy in his blood, which may be explained partly by an interaction between the drug and ritonavir. Ritonavir boosts the amount of ecstasy in the blood stream by between 200 to 300 per cent, because the body uses the same process to break down both ritonavir and ecstasy.
There have been hospitalisations due to adverse reactions to ecstasy among people taking ritonavir and other protease inhibitors. Another class of anti-HIV drugs, known as NNRTIs - efavirenz (Sustiva) and nevirapine (Viramune) - as well as many other drugs are metabolised using a similar process. So there is a risk that ecstasy could interact dangerously with them.
If you’ve started a new treatment combination recently, the first four weeks when your body gets used to the new drugs are likely to be the riskiest time for interactions. Some doctors suggest that after this period, if you choose to take ecstasy, it may be safer to begin with a quarter or half a pill first.
What about other drugs?
Blood levels of amphetamines and GHB are also increased by ritonavir. GHB is a dangerous drug in its own right in any case, whether you are an experienced recreational drug user or not. While a slight boost to amphetamine levels is just likely to keep you awake longer, slight changes in GHB levels can make you pass out and stop breathing. Using GHB with any drug of the protease inhibitor or NNRTI class is likely to be dangerous. A death has been reported in someone who took it while on ritonavir/saquinavir (Invirase, Fortovase).
I think I’ll steer clear of pills. What about a few lines of ‘k’ or coke - surely that can’t hurt?
Ketamine may not mix well with some antiretrovirals, especially ritonavir-boosted combinations. These will boost ketamine levels, possibly leading to violent overheating, difficulty breathing and loss of consciousness. Cocaine can increase the risk of heart attack, as do anti-HIV drugs. A study found that mice regularly exposed to cocaine lost a lot CD4 T-cells. Although you probably aren’t a coke-snorting rodent, this might mean that HIV could progress faster if you use coke regularly.
How about a joint? Surely they don’t call it ‘medical marijuana’ for nothing?
Despite the fact that smoking is bad for you, there is no evidence suggesting that marijuana has any effect - good or bad - on the immune system of people living with HIV. However, marijuana does reduce testosterone levels and, as with all smoking, can harm the lungs.
Sounds like I’ll be sticking to booze, then. Surely that’s okay?
Very few anti-HIV drugs are affected by alcohol, although the pancreatitis risk of some drugs, such as ddI (didanosine, VidexC), may be increased if you drink heavily, in the view of some doctors. Pancreatitis and peripheral neuropathy are in any case associated with heavy alcohol consumption. Alcohol may also affect your liver’s capacity to process antiretroviral drugs and may increase nausea. If you are also infected with hepatitis C, then alcohol is likely to damage your liver even more.
Are you sure your name isn’t Scrooge?
We’re just giving you information; it’s up to you what you do with it! One last thing, though: remember that you may find yourself missing doses if you are ‘out of it’ because of drug or alcohol use, and that this could lead your treatment to fail.
Here’s to a happy - and healthy - New Year!
• NAM provides information to help you think about your use of HIV treatments, but this is not intended to replace discussion with your doctor.
Visit NAM at www.aidsmap.com
