Hi Pozziepinoy,
I am currently taking may arv's particularly effavirenz, lamivudine and tenofovir. During the christmas break, i got invited to a party and we took recreational drugs namely methamphetamine and amphetamine. I would like to ask if it has any effects on the effectivity of the arv's or will it cause my cd4 count to go down or the virus to become resitant to the arv's.
Thanks.
XOXO
CONTRIBUTOR'S RESPONSE
Hi XOXO,
Thank you for your email and thank you for reading this blog,
The use of Amphetamine and it's synthetic form, Methamphetamine, have an extremely detrimental effect on people living with HIV. But before we discuss that, we need to quickly establish exactly what these drugs are.
What are Amphetamine and Methamphetamine?
They are psychostimulant drugs. They cause a large increase in the concentration of the neurotransmitters, Norepinephrine, Dopamine and Serotonin, in the brain. This leads to an unforgettable, extremely elevated artificial pleasure sensation or "high" with a perceived sharpening of the senses and heightened sex drive. However, there is an extreme low or "crash" that follows. The only quick way to recover from this "crash" is to use more of the drug. However, the brain adapts to these drugs almost immediately. There is an effective down regulation of the release of these neurotransmitters, especially Dopamine. Consequently more and more of the drug is needed to reproduce the "high". Thus Amphetamine, and in particular Methamphetamine, are extremely addictive.
What are the effects on people living with HIV?
People using Methamphetamine are more likely to become infected with HIV or infect others. Due to its disinhibitory effect, people are more likely to forgo safer sex practices such as correct and consistent condom use. It also allows for prolonged sexual activity increasing the risk of genital and anal sores and abrasions further increasing the risk of HIV transmission. It also leads to teeth clenching and grinding causing sores and abrasions in the mouth. These can turn typically low risk sexual activities into high risk ones as HIV is able to enter through them.
Regarding their effects on the CD4 count, it hasn't been fully determined whether Methamphetamine use can ,on it's own, cause a decrease in the CD4 count in humans yet. The long term use of Amphetamine or Methamphetamine rarely legally. Thus it's long term effects on the CD4 count is difficult to conduct controlled studies on. However, it has been shown to increase the viral load and decrease the CD4 count in the 2 test tube and in mice studies I have been able to find so far. The CD4 count of users however, is likely to fall rapidly due to lifestyle factors such as a poor diet, lack of exercise and severe sleeping disorders.
Amphetamine and Methamphetamine will have a detrimental effect on the effectiveness of your particular ARV's for 3 reasons.
1) The unwanted side effects of Efavirenz are increased when used with mood altering drugs such as Amphetamine and Methamphetamine.
2) Their use makes adherence to an ARV regimen more difficult. Studies have documented more substantial brain damage and cognitive impairment amongst HIV+ Methamphetamine users than non users. Users experience paranoia, short term memory loss, rages, mood swings, insomnia and sleeping disorders leading to missed doses. HIV has the highest mutation rate of any virus. Any lack of adherence to your ARV regimen increases the likelihood that the virus will become resistant to the ARV's you're taking. Lack of adherence to any other medication you might be taking for any opportunistic infections (OI's) can also occurs for the same reason. Like HIV, the causes of any OI's can also develop drug resistance and thus not respond to treatment.
3) Amphetamine and Methamphetamine, like many of the ARV's, are metabolized by the liver. There is no way to be certain of the "purity" of these drugs when they are obtained illegally. They can be synthesized in a number of ways and the equipment used is almost certainly not free from contaminants. Consequently, they may contain numerous compounds that could interfere with the metabolism of any of the ARV's.
Note: Although you are not on this ARV, Aluvia (Kaletra) contains a protease inhibitor called Ritonavir. This can increase the levels of Amphetamine and Methamphetamine to potentially life threatening levels.
Finally the highly addictive nature of these drugs and their detrimental effect on the mental health of the users can lead to people forgoing medical care altogether. The world tragically saw this in action with the recent passing of Spencer Cox. He was an HIV/AIDS activist who helped develop effective protease inhibitors. He saved the lives of millions but he couldn't save his own. He developed a Methamphetamine addiction and ceased his ARV treatment. He died of an AIDS related illness on December 12th 2012 of an AIDS related illness.
There is no real recreational level of use for Methamphetamine. It is highly addictive and is becoming a major health issue world wide. If have used this drug, even just a few times, please strongly consider stopping it's use immediately. If you are unable to do this on your own, and most people aren't, then please consider enrolling in a rehabilitation program run by well informed health care professionals and drug counselors.
I hope you have found this answer helpful.
Credits: www.aidsmeds.com
http://online.liebertpub.com/doi/abs/10.1089/aid.2008.0282
(Aids Research and Human Retroviruses)
http://www.labome.org. (Novel mouse models for understanding HIV-1 pathogenesis Aviva Joseph Department of Microbiology, Albert Einstein College of Medicine, Bronx, NY, USA)
Stay healthy and compliant with your ARV regimen,
Malcolm Brown
International Contributor
"WE ARE ALL IN THIS TOGETHER.
NO PLHIV is alone with his or her struggle with HIV!"
-Pozziepinoy-
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Credits:
Hi Pozziepinoy,