HIV and Addiction

People use alcohol or other recreational drugs for a variety of reasons. Not all people who use substances have concerns about their use, experience negative outcomes, or want to cut down/quit. For some people, the use of substances may be causing problems in their lives and they may consider harm reduction strategies, cutting down or quitting altogether.

Substance use and addiction can be a potential factor when we consider HIV transmission and living with HIV/AIDS. “Research findings clearly show that the use of alcohol and other substances of abuse is a factor in the spread of HIV and can complicate the long-term health outcomes of HIV-positive individuals.” (National Institute on Alcohol Abuse and Alcoholism, 2002). Substance use and addiction can be a factor in HIV transmission as it may impact decision making. This can make it more difficult to use clean needles when doing injection drugs or to negotiate condom use when having sex.

When thinking about substance use and addiction for people living with HIV/AIDS, Canadian AIDS Treatment Information Exchange notes the following: “Ecstasy and crystal meth (“Tina”) may reach dangerously high levels in the blood in combination with a PI {protease inhibiter} 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. 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.” (CATIE, nd.)

Substance addiction can also potentially impact HAART Adherence. One study found that “current {substance} users were significantly less likely to be adherent than former, or never users” (Hicks PL, et al, 2007). Other sources indicate that substance addiction may impact HIV disease progression. NIDA reported that “Drug abuse and addiction can also worsen the progression of HIV and its consequences, especially in the brain. In animal studies, methamphetamine increased HIV viral replication; in human methamphetamine abusers, HIV caused greater neuronal injury and cognitive impairment compared with nondrug users”. (2005). “Heavy alcohol consumption has a negative impact on the CD4 cell count in HIV-infected persons not receiving ART. In addition to the known deleterious effects of alcohol on ART adherence, these findings suggest that avoiding heavy alcohol consumption in patients not on ART may have a beneficial effect on HIV disease progression.” (Samet, JH, et al, 2008)

AIDS Calgary is committed to a harm reduction and human rights based approach in service delivery. We accept that abstinence from risk behavior (such as substance use) may not be desired or possible in some life circumstances. We value individual rights to self determination and recognize that not everyone wants to cut down or quit using substances. There are harm reduction strategies that can keep you safer while still using. This could include not sharing needles or pipes, finding out more about recreational drug interactions, talking with a support person about your own goals, health information and education, replacement therapy such as methadone, and so on.

If you are living with HIV you can connect with a Case Manager at AIDS Calgary to talk about a variety of options, including harm reduction strategies, counseling and support. AADAC (Alberta Alcohol and Drug Abuse Commission) can also provide information, counseling and residential or outpatient addiction treatment programs. For more information see: http://www.aadac.com/default.asp or the 24-hour AADAC Help Line 1-866-332-2322

It is important to consult with knowledgeable pharmacist/physician for current information and strategies on minimizing drug interactions.

Sources
Canadian AIDS Treatment Information Exchange (CATIE). (nd) Recreational Drugs and HIV. Retrieved March 24, 2009 from http://www.catie.ca/treatmentFAQ_e.nsf/c3f8add81db5bbbb85257188005be34b/89705028c888b02185256f0f0056c9a0!OpenDocument

Hicks PL, Mulvey KP, Chander G, Fleishman JA, Josephs JS, Korthuis PT, Hellinger J, Gaist P, Gebo KA; HIV Research Network. (2007) The Impact Of Illicit Drug Use And Substance Abuse Treatment On Adherence To HAART. AIDS Care. 2007 Oct;19(9):1134-40. Retrieved March 24, 2009 from http://www.ncbi.nlm.nih.gov/pubmed/18058397

National Institute on Alcohol Abuse and Alcoholism (NIAAA). (2002). Alcohol Alert #57. Retrieved March 24, 2009 from http://pubs.niaaa.nih.gov/publications/aa57.htm

Samet JH, Cheng DM, Libman H, Nunes DP, Alperen JK, Saitz R. (2007). Alcohol Consumption and HIV Disease Progression. J Acquir Immune Defic Syndr. 2007 October 1; 46(2): 194–199. Retrieved March 24, 2009 from http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2247363