Interactions between HIV treatments and recreational drugs

The much-publicised death of an HIV-positive clubber on London's gay scene threw the spotlight on the possible interactions between treatments prescribed for HIV infection and recreational drugs. This section aims to set out helpful up-to-date information. Any drugs which inhibit the liver enzymes needed to break down other drugs. Chiefly these are protease inhibitors (PIs), drugs used in the treatment of HIV-related illnesses such as ketoconazole and itraconazole (anti-fungal drugs) and a new anti-HIV drug called non-nucleoside reverse transcriptase inhibitors such as neviropine and delaviridine. It's important to stress that any interaction is possible but by no means a certainty. Most of the press speculation centred on the PI ritonavir. The information here is derived from interactions with ritonavir. It may be true of other liver enzyme inhibiting drugs, but to a lesser extent. So what's the score? It's difficult to predict an interaction between a pharmaceutical drug and an illicitly-manufactured one because:

The chemicals in street drugs are not consistent in terms of strength or content (how often does an 'E' actually have MDMA in it?)

We all have different reactions and sensitivities to drugs. Some have overdosed on relatively small doses. Others have survived massive overdoses.

No actual experiments have taken place into the interactions. What is the interaction? Because PIs have the potential to inhibit liver enzymes, they can slow the rate at which our bodies excrete other drugs. It's rather like rush hour at the tube station! If all the barriers are open, everyone can get through easily. If half the barriers are closed, more people are competing for fewer gates, and a build-up begins. The level of the illicit drug and any breakdown products in your bloodstream can rise to higher than normal levels, which may cause you serious problems. Can this happen with all recreational drugs? No. The drugs with which they may interact badly are:

MDMA (ecstasy).

Speed (amphetamine sulphate).

Anabolic steroids.

Ketamine.

Benzodiazepines (eg valium, temezepam, rohypnol)

Lustral and Prozac (anti-depressants).

Opiates, eg heroin, morphine and methadone. With all of these, there is likely to be a minimum twofold increase in blood levels. With ecstasy and valium this is potentially much higher (up to ten times). Whether you are sensitive to these drugs at such levels will depend on your individual metabolism and whether your liver enzymes have been inhibited. Drugs such as cocaine, crack, alcohol, GHB, poppers, cannabis and LSD are currently thought not to interact seriously. Reducing the harm During the first six weeks of treatment with PIs, blood levels of these drugs are at their highest, while your body gets used to the chemicals. The risks of a bad interaction are probably greater during this time. It's best to avoid taking the recreational drugs listed above during that time. After six weeks, if you choose to use the drugs affected by PI's, the table below gives an example of advice you are likely to receive.

Esctasy

Divide dose. Take a tablet and wait and see what effects you feel. Avoid ecstasy use within first six weeks of commencing PI treatment.

Speed

Don't be greedy! Dab little bits rather than bomb the lot and see what effect it has. Remember that if you're snorting or injecting you'll need to be extra careful.

Heroin

Take normal dose initially and increase it if you experience withdrawal effects.

Methadone

Consult your drug dependency unit (DDU). Only take as much as you need: if you normally take 90mls a day, try just 30mls and see what effect that has. Only take more if you start to withdraw or you may get tolerance and increased dependence.

Valium

Increases in your blood 2-10 fold. It's best not to use this recreationally. Consult your doctor if you use it on prescription.

Temazpam

If it's on a prescription, consult your doctor. Reduce your usual dose and only increase it if you're not getting your usual effect.

Rohypnol

Start by halving the dose. Give it chance to work. Increase only if necessary.

Steroids

Talk to your HIV doctor before starting PIs or steroids together. Start with half of the dose you usually use and see what happens. Only increase if necessary.

Ketamine

Start off with a smaller dose (say, one third of your usual dose). Wait for effects before taking more. Only take more if you feel you need to. Don't forget the effect is sometimes delayed. This online advice guide is an extract from the book TOGETHER, by kind permission of Patriic Gayle and Gay Times Books. The book itself is over 300 pages long and contains:

several chapters more useful advice and information

more in-depth information in some chapters

more pictures and tables

further contacts at the end of each chapter

a comprehensive listing of gay and health organisations Described by Qx magazine as a 'Gay Bible', Together Book is a practical reference work no bookshelf should be without.

Available from Prowler Stores and all good bookshops, or click the link below for price and ordering details.

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