When two drugs are taken at the same time, their interaction can affect drug effectiveness and side effects. This is the case for both prescription and recreational drugs, although there is much less medical research into drug interactions with illicit drugs. But we do know that some anti-HIV and some recreational drugs are metabolized (processed) by the same "pathways" in the body. This can change the effect of one or both drugs when they are combined. This applies to some, but not all antiretrovirals. Similarly it only affects some recreational drugs.
However, recreational drugs are rarely sold in a pure form, so it is difficult to know what they contain. They may have been “baptized” with other substances and may contain larger or smaller amounts of active ingredient than expected. Predicting how recreational drugs will interact with HIV drugs is not simple, and it is best not to combine them.
Ritonavir and cobicistat
The two ARV (antiretroviral) drugs most likely to be involved in harmful interactions with recreational drugs are ritonavir (Norvir) and cobicistat Tybost.
These two agents are used as potentiators of other drugs taken to increase levels of other antiretroviral drugs. The addition of a small dose of one of these agents causes the liver to process the main drug more slowly, that stays in the body for longer or at higher levels. Without agent booster, the prescribed dose of main drug would be ineffective.
The booster mechanism may also affect recreational drugs. The liver processes recreational drug use more slowly, resulting in the effects of recreational drugs remaining in the body for longer or in large concentrations. (note from seropositivo.org editor: In short, an extra tablet, or an extra bite can become the "end of the line for you"
Sometimes this can cause serious side effects or an overdose (NES: "End of Line")
If your HIV treatment includes a protease inhibitor, you are probably taking ritonavir Norvir () or () cobicistat Tybost. Protease inhibitors include darunavir (Prezista), atazanavir Reyataz () and lopinavir (Kaletra).
Also taken with Cobicistat is the integrase inhibitor elvitegravir (Vitekta).
It is included in the combination with elvitegravir Stribild tablets (tenofovir disoproxil and emtricitabine), Rezolsta (with darunavir) and Evotaz (with atazanavir).
Ritonavir is also in a combination pill used to treat hepatitis C called Viekirax ombitasvir and pariteprevir (com).
If you are not sure which medications you are taking, the staff at your HIV clinic can tell you.
Interactions dangers of recreational drugs
A dangerous interaction is possible between ritonavir or recreational drugs. It is also fact for the case of use of cobicistat and others with:
- Crystal methamphetamine (Crystal, tina, meth)
- The MDMA (ecstasy, X, mandy)
- (miaw miaw Mephedrone, vegetable, bath salts)
- Ketamine (K, vitamin K, Special K)
- Drugs That Deal With Erectile Dysfunction (Viagra, Cialis and Levitra)
- Benzodiazepines (benzenes, Valium, Xanax)
Interaction can increase the intensity of recreational drug use, sometimes to unpleasant or even dangerous levels.
Experts have assessed the potential for interactions with the first three drugs listed to be of "moderate risk" and the last three to be of "high risk." There have been a number of documented cases of deaths and serious side effects in people taking ritonavir and Crystal Meth, MDMA or ketamine.
Heavy use of ketamine can lead to damage to the liver and biliary tract. Overdose of drugs for treatment of erectile dysfunction are dangerous for the heart. An overdose of benzodiazepines can result in death of the person.
Drugs for erectile dysfunction may interact with Poppers, which causes a potentially dangerous drop in blood pressure. This may be more likely if you are also taking ritonavir or cobicistat.
For GHB (gamma-hydroxybutyrate) and GBL (gamma-butyrolactone), the risk of interactions is unknown but the possibility can not be ruled out,
Reverse transcriptase inhibitors
Relative to non-nucleoside reverse transcriptase inhibitors (NNRTIs), a different type of interaction is expected since these drugs are metabolized differently. Interaction may result in levels of recreational drug use being less than would normally be expected. This applies specifically to Sustiva efavirenz, also the components of the Atripla), nevirapine (Viramune) and etravirine (Intelence). In contrast, rilpivirine (Edurant) interaction with recreational drugs was not evaluated.
The interactions may (could?) Occur with cocaine, ketamine and drugs for erectile dysfunction ..
Drugs without significant interactions
The potential for interactions with various other substances is considered low. This includes alcohol, cannabis, poppers, heroin and other opioids.
Likewise, several antiretroviral drugs were not evaluated in their possible problems with "drug interactions". These include:
- All of the reverse transcriptase inhibitors (NRTIs)
- (Edurant rilpivirine), one of the non-nucleoside reverse transcriptase analogs
- The raltegravir (Isentress)and dolutegravir (Tivicay), both integrase inhibitors
- Maraviroc (Celsentri), a CCR5 inhibitor
There is a website that works with the drug interactions of the University of Liverpool HIV Drug site (www.hiv-druginteractions.org) and publishes a Recapitulative table of possible interactions Interactions
The first four weeks taking a new combination of ART, when your body gets used to the new drug, they are likely to be one of the most risky moments for interactions. Editor's note: “If you love life, and even the possibility of continuing to enjoy these trips (...) for longer, make an effort and hold your fissure for four weeks. May you not even need it during these four weeks to enjoy life !!! ”
A frank discussion with your doctor or pharmacist who specializes in HIV HAART can give you a better understanding of the risks, based on your own situation. If you do not want to stop or can not stop using recreational drugs, switching to HIV treatment with less potential for interactions may be an option.
Recreational drugs have a wide range of impacts on physical and mental health, both in the short and long term. You can find more detailed information about its effects and legal status on the FRANK website http://www.talktofrank.com). (This website makes legally relevant assessments of people living in England or other places that are part of what is called “United Kingdom”
Drug uses may interfere with sleep patterns and routines, making missed doses of your HIV treatment more likely.
In sexual situations with concomitant use of drugs can affect your thinking about what is safe and what is not safe or appropriate. You may be more likely to put yourself at risk for infection or other STDs such as hepatitis C, syphilis and (why not say it?) "Boring", HIV among a myriad of infections to sexually affections communicable diseases. If you inject drugs, it is important not to share or reuse equipment with others (including water, swabs, filters, spoons, and tourniquets).
If you are concerned about your drug use, there is information and support available. You could start by talking to the staff at your HIV clinic. You can also search local services on the FRANK site. In London, specialized services are available at CRD.
By Roger Pebody from Aidsmap
Soropositive Editor's Note.Org: I am not a cynic and I do not see myself as having the right to interfere in the personal lives of people who eventually read me, so I will not adopt the “Don't Use Drugs” stance. If you are going to use them, use them safely.
But I let a council in particular:
In all my life, ever since I was homeless (5 years) and over 12 or 13 years I've lived in the “Night”, I have never seen anything with the destructive power of a human being, both physically and morally. . I remembered now a girl I loved for her beauty, kindness, and good humor, who came down so much with crack that she even offered herself (a night of sex) for a crack stone. Obviously I didn't go, but it didn't take 5 minutes for her to find the bastard who accepted the exchange. Goddammit!
Today (2016) I think I could have accepted the exchange, allowed her to use crack and not had sex with her that night, and instead tried to elucidate her about the way she was living… It doesn't matter anymore nothing because she's dead
Translated from English, whose original is in Interactions between HIV treatment and recreational drugs By Cláudio Souza. Still reviewing