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HIV Infection and Substance Abuse

This section includes the treatments of people living with HIV and effects of their substance abuse on their treatments. Substance abuse is classified into several groups and they have different effects.

Stimulant and drug abuse are particularly known to have negative effects on HIV transmission and management of an existing infection. In recent years, effects of using a chemical substance called “chemex” during sexual intercourse on HIV spread has been subject to academic researches. Stimulant or drug abuse have been reported in 40% of people living with HIV who are inpatients at Chelsea Hospital and Westminster Hospital in UK. Half of people who reported their substance abuse admitted to using substances to increase sexual power and have chemical sex (chemsex). (1)

Even if not IV drug use, substances taken orally or by inhaling, or another way, are known to negatively affect the protection habits and cause ignoring the risks facilitating HIV transmission.

Health authorities advise everyone to stop stimulant and drug abuse, particularly people living with HIV.

Tobacco Products, Alcohol and Marijuana

In some HIV types with genetic mutation; tobacco products, alcohol and marijuana have been reported to cause the medication active ingredients to be lower than required (2).

Tobacco and its products also have negative effects on CD4 cells by damaging the immune system. They also have an increasing effect on development of heart and lung diseases. And along with other diseases they cause, HIV treatment becomes complicated and difficult.


Levels of MDMA, the main ingredient of ecstasy pills, interact with many medications.

Active ingredients of your medications will probably make the ecstasy effect two or three times stronger depending on the MDMA levels in the ecstasy pill, causing overdose.

Overdose-related deaths due to using ecstasy with antiretroviral medications have been reported.


If this recent popular substance is used with protease inhibitor or another medication whose active ingredient is protease inhibitor, it can be life-threatening. In last years, a case in which coma was developed due to GHB use with the medication has been reported, whereas no negative effects of GHB have been observed in that person before starting the antiretroviral treatment (3).

Crystal/Crack/Poppers (Amyl Nitrite)

Australian doctors reported that there’s a life-critical interaction between methamphetamine, which is known as ‘crystal’ or ‘crystal meth’, and some antiretroviral medications. A 49-year-old in Melbourne was found dead at their home next morning, after smelling Methamphetamine and poppers (amyl nitrite). According to the autopsy report, high dose of methamphetamine was found in deceased’s blood. Doctors stated that protease inhibitors might have slowed down the methamphetamine metabolism and caused overdose with Poppers (4).

Methadone and Heroin

There’s an interaction between antiretroviral medications and heroin. While methadone and heroin levels increase in some interactions, sometimes medication level in blood increases. Using with antiretroviral treatment is not recommended, but transformation treatment can be utilized by making methadone dosage adjustments in heroin addiction treatment.


Although there’s no published study on utilization of ketamine with antiretroviral treatment, it’s known that ketamine effect in blood would increase and cause overdose-related health issues when used with protease inhibitors and NNRTIs.

Viagra (Sildenafil)

It’s known that sildenafil level in blood would increase and health issues would develop accordingly when used with specific antiretroviral medications. You must absolutely consult your doctor if it will be used for sexual function disorders. There are no publications demonstrating the relation between antiretroviral medications and substance abuse.

All information above is based on clinical observations and reasonings.

Although no negative effects of using medication with substance abuse have been observed, given the example of London case, people living with HIV are advised against substance abuse in order not to experience anything that would cause fatal results. Even if it has no medication interaction, substance abuse poses a risk for everyone, no matter if they’re living with HIV or not, due to its effects such as abandonment of medication intake and protection habits,

Note: As per Article 191 and 188 of Turkish Criminal Law, drug use, possession and drug dealing are prohibited whatsoever, and penal sanctions shall be executed in such cases.

This section does not encourage stimulant and drug abuse.

This section aims to inform people living with HIV on the risks they might face, and particularly aims to reduce the cases resulting in death as much as possible, and also to reduce the harm to themselves and others to minimum.

2 Ma Q et al. Tobacco and marijuana uses significantly decrease atazanavir (ATV) trough concentrations in HIV-infected individuals. 49th Interscience Conference on Antimicrobial Agents and Chemotherapy, San Francisco, abstract H-231, 2009

3 Harrington RD et al. Life-threatening interactions between HIV-1 protease inhibitors and the illicit drugs MDMA and gamma hydroxybuytrate. Arch Intern Med 159: 2221-2224, 1999

4 Hales G et al. Possible fatal interaction between protease inhibitors and methamphetamine. Antivir Ther 5: 19, 2000