Forum on Substance Use and HIV

Cocaine interaction with hiv meds

Tue, 09 Jan 2018 00:06:34 -0400

Q: Hi Doctor. Is there any info about how cocaine consumption interacts with hiv medication (in this case its about a patient Ive been treating for his addiction problem, who just started the 2 meds treatment and consumes cocaine by snorting). thanks!

A: Thanks for your excellent question. Research on interaction between antiretrovirals and recreational drugs is somewhat limited because of funding restrictions but here is what we know:Cocaine is metabolized by the CYP3A enzyme in the liver. Some HIV drugs (including NNRTIs and PIs) are also metabolized by the CYP3A enzyme. Thus there is a potential for cocaine-ART interaction causing liver damage. You can read about this in more detail Read More

Alcohol and HIV medication: are there harmful effects?

Mon, 27 Nov 2017 17:27:21 -0400

Q: I see the risk of missing dosage from drinking too much alcohol on many different sites, but what is the physical risk on the body of drinking too much alcohol without missing dosages of HIV medication? I considered too much alcohol to be one or two glasses a day and 2 to 3 days a week drinking three to four glasses of beer, hard liquor, or wine and maybe once a week getting intoxicated to the point that it's probably not safe to drive)

A: Thanks for your great question! Despite the fact that there is increased alcohol consumption among people living with HIV/AIDS, there is unfortunately not a lot of research on potential interaction of alcohol and antiretroviral medications (ART), although we are learning more all the time. Current research tends to be very focused and limited in scope. For example, this European study found that alcohol synergistically...

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Missed with meth iv use

Sat, 04 Nov 2017 15:53:37 -0400

Q: How can I treat the knot after a miss and what creams should be applied?

A: Hello and thanks for writing. Here is a response to a similar question:You can treat missed shots with warm compresses to reduce the likelihood of irritation or abscesses. Only apply creams or salves after the wound has closed (at least a couple of hours). If it starts to look or feel bad you may have an infection and should seek medical treatment immediately.Injecting crystal meth doesn't have a happy ending. Please consider getting assistance at Crystal Meth Anonymous, SMART Recovery, or some ...

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Alcohol and Truvada

Sun, 22 Oct 2017 18:58:16 -0400

Q: Is it dangerous to drink while taking Truvada, I'm on it for preventive purposes, and am wondering am I doing myself any harm by drinking alcohol?

A: Thanks for writing. Antiretroviral medications, including Truvada, do not interact with alcohol, so there is no concern from a drug interaction perspective. There would be a concern if you are drinking to excess and might miss your dose of Truvada or, under the influence of alcohol, engage in higher risk sex. In such cases you should still be protected from HIV but increase your risk of acquiring other STIs, not to mention the consequences of too much drinking.It is interesting to note that sexu...

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HELP QUESTION ECUADOR

Fri, 06 Oct 2017 19:29:59 -0400

Q: Hello Doctor.Six months ago I was diagnosed with hiv with 20,886 copies of viral viral load and 246 of cd4. Four months ago started the treatment of Tenofovil, Efavirenz, Emtricitabine. The second month that I started with the doctor's treatment told me that my viral load was significantly low and I am undetectable. I am 21 years old and like all young people. I want to go out with my friends. My question is if while I'm drinking liqueur I can take the pill? Most of the time I drink liqueur I do...

A: Hello and thanks for your question. It is a common concern about alcohol's effects on HIV medications. Generally, it is considered safe for someone on HIV medications to have one alcoholic drink per day. That quantity should not interact with your medication.The psychological effects are another concern, however. Of course you know it is important to take your medications as prescribed so falling asleep and missing your dose is something you do not want to do. I'm sure young people in Ecuador en...

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Complera and food

Fri, 08 Sep 2017 19:10:10 -0400

Q: Hello Dr! I just started Complera and I'm not sure if taking my medication just after breakfast (instead of during breakfast) is safe. Thanks a lot!Regards,Alejandro

A: Thanks for writing. I am going to repost this response from Dr. Ben Young about Complera and food.Best,David

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Sick after taking alcohol

Sun, 03 Sep 2017 14:35:37 -0400

Q: Ever since i've started treatment, i noticed that each time i had a bit too much of alcohol, i'll feel sick and lethargic before it goes away within 2 days. is this normal or is this a cause of concern?

A: Thanks for writing. There is no known interaction between alcohol and antiretroviral meds but your symptoms don't lie. You don't mention how long you've been on meds. If you are still adjusting to them that may be a factor. I would listen to your body and adjust your behavior accordingly.It is recommended that someone on HIV have only one alcoholic drink per day. You mention sometimes having a "bit too much." Please be alert to any excess drinking since it can reduce inhibitions resulting in hig...

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Does alcohol affect HIV medications?

Tue, 08 Aug 2017 19:52:08 -0400

Q: Hi. I was detected HIV three months ago. My cd4 was 752 and viral load I still don't know. I started to take lamivudina, tenofovir and efavirenz all at 8:00 at night. In these 3 months I have drunk alcohol moderately at least one time per month. Can it can affect my adherence to treatment?. And do we have to avoid alcohol at all? Or can I can drink at a party normally once a month or do I really have to avoid it. Thanks.

A: Hello and thanks for writing. It is good that you were able to begin treatment while your viral load is still high. It is generally considered safe for someone to have one alcoholic drink with HIV medications. I'm not sure what you mean by drinking "moderately" - that can mean different things to different people. One drink when you go out will not interfere with your HIV medications.Because you just tested positive three months ago you are still undergoing a period of adjustment. During that ti...

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Slamming meth

Tue, 08 Aug 2017 19:28:04 -0400

Q: I'm new the banging dope. This guy I know been banging me in my arm. Today I'm not sure what he was on but I am pretty sure he missed my vein. My arm is swollen and hurts when I bend. I didn't get that rush u suppose to get when u bang. What should I do?

A: Thanks for writing. If an injection misses the drug you ingested will get slowly absorbed. If that doesn't happen you should seek medical treatment.When there is a miss, there is a highly increased chance of infection which can develop very quickly. Initially it is useful to apply warm compresses to help the swelling go down. If the site becomes warm or hot to the touch or red and inflamed, you need to get medical attention immediately. Such infections can travel through the bloodstream and are ...

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Poppers how dangerous?

Thu, 03 Aug 2017 15:14:46 -0400

Q: How dangerous are poppers in your opinion?

A: Thanks for writing. Poppers have been around a long time and are so common (at least among gay men), that many people assume they are totally benign.There are a few things to consider when using poppers (alkyl nitrites, sometimes sold as video head cleaner). Does anyone have a video deck any more?). Poppers are vasodilators, meaning they dilate blood vessels giving a "rush" that is pleasurable. This also causes a drop in blood pressure.There can be risk of interaction if someone who is already o...

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Prep and Fever?

Wed, 19 Jul 2017 06:11:11 -0400

Q: I started Prep recently and on my first dose I had fever.Took the double dose around 8pm and at 3am i woke up with fever shaking so i took paracetamol and started feeling better. Next morning i was perfectly fine.So i went to the clinic and asked if that was a side effect and they side Tenvir-EM doesnt react that way and was maybe something i ate for dinner (had fish so maybe food poison?).They recommended to try again and when i did i felt perfectly fine.I saw an article where a guy started pre...

A: I say blame the fish! Or, to be more scientific, it is quite unlikely to nearly impossible this could be from PrEP. First of all, fever is not a reported side effect from any efficacy trial, nor listed by the manufacturer on the warning label. Also, if you were one of the less than 10% of PrEP consumers who experiences side effects from starting, then it usually takes a few days or weeks to develop. They generally don't start immediately in the first few hours. Aside from the seafood, I wonder...

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Essential oils interactions with Nevirapine and Tenofovir

Thu, 15 Jun 2017 14:23:42 -0400

Q: I have been HIV positive since 2006 and take Nevirapine and Tenofovir. I recently started an aromatherapy school where I learned the possibility of ingestion of essential oils for healing minor heath problems. Being essential oils volatile aromatic molecules formed of terpene hydrocarbons, simple and terpene alcohols, aldehydes, ketones, fenois, esters, ethers, oxides, peroxides, furans, organic acids and others, I would like to know if there' a risk of drug interactions with the drugs I make us...

A: Hello and thank you for your question. Congratulations on studying aromatherapy. In my experience there are many beneficial effects of essential oils. I know of no research documenting potential interaction between HIV medications and essential oils. They do get absorbed systemically and there is a chance that they can impact the absorption and/or metabolism of your drugs.Your best bet is to discuss this issue with your physician. It is always important to tell them about any supplements, oils, ...

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edible Marijuna vs smoked effect on immune system

Thu, 15 Jun 2017 14:13:35 -0400

Q: I see plenty of information about smoking pot, its effect on your lung health and even lowering your immune system a bit. However I'm trying to find info on immune system effects of edible pot, say cooked in food, pot oil etc. So far I can not find info about immune system effect of edibles.. I would assume consuming it would have less of a bad effect on your immune system, any idea?

A: Thanks for writing. I know of no research examining the differences of smoking versus edible marijuana on the immune system. One problem is that research on drugs has been significantly limited in the US due to our drug control policies.The beneficial effects of marijuana have been documented for certain medical conditions, including many of those associated with HIV/AIDS. I would caution anyone with an addictive history to use medical marijuana with care (if at all) since, although there is a h...

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Serodiscordant and increasing substance abuse

Thu, 15 Jun 2017 14:02:25 -0400

Q: I was diagnosed in 2012 and only started taking meds about less than 3 months ago as my viral load was 800 copies/ml but CD4 count was always between 1400-1200. I did another test after two months on treatment and my viral load is 40 copies/ml but my cd4 dropped to 736. To give you more background I disclosed to my boyfriend of two years before I started taking my meds. He was and still is negative. It has put a strain on our relationship and we both started to increase our alcohol and cocaine i...

A: Hello and thanks for your question. I am glad to hear you are on your medications. All research indicates that starting and consistently taking your medication is vital for your health.You describe several issues in your relationship that I would like to address.The first concerns power issues and control. Any relationship needs to be based on equality and mutual respect. If is, of course, a challenge for someone to hear that their partner is living with HIV, but there are support systems for th...

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My doctor is only giving me Truvada

Sat, 20 May 2017 16:28:45 -0400

Q: Hello doctor. I hope you are having a great day. Today I'm about to start my treatment but what calls my attention is that the only medication my doctor is giving is Truvada. Normally, and actually a lot of friend who have been HIV+ for years have told me that Truvada is always combined with another medication. It is important to say that I suffer of epilepsy and that my CD4 count is above 800. I asked my doctor of course of why he was only giving me Truvada and this was the reason that he gave ...

A: Hello and thanks for posting.Do not start Truvada alone for HIV treatment. Your many friends are correct. You need a different doctor. Truvada (FTC/tenofovir DF) alone is not a treatment for HIV. Indeed, two drug therapy for HIV is currently only an experimental approach, and then only with certain medications. Two drug therapy with NRTI (nukes) like Truvada are very specifically not recommended, as the risk of treatment failure and irreversible, life-long viral drug resistance is substantial...

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Atripla

Sun, 12 Mar 2017 17:25:47 -0400

Q: Can atripla give me a false positive for marijuana?

A: Yes, there have been several published reports, that depending on the urine drug screen assay used, efavirenz (contained in Atripla) could result in a false positive result for marijuana (THC).

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Prep and chem sex

Tue, 07 Mar 2017 19:08:39 -0400

Q: Hi Doc,I was wondering whether there is any significant interaction between Prep and chemsex?

A: Thanks for your excellent question about interactions between chemsex and PrEP. Chemsex is the use of certain recreational drugs in conjunction with sex and, by definition, almost always high-risk sex. The drugs most frequently used are methamphetamine, cocaine on occasion, GBH (Gamma Hydroxybutyrate), and (mostly outside the US), mephedrone. Depending on availability, price, and law enforcement efforts other drugs may be substituted for these.In my opinion, chemsex is almost always high-risk. ...

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Meth using after surgery

Sun, 12 Feb 2017 19:15:37 -0400

Q: Is it bad to smoke meth after surgery?

A: Thanks for your question. Meth use is never a good idea before or after surgery. That said, I understand that many people requiring surgery may also have a meth problem. Meth can interact with other drugs, including anesthetics, because they are often processed by the same liver enzymes. It is important to let the anesthesiologist know you are a meth user.As for post-surgery, meth use can increase your chances of infection and, in my experience, the use of meth usually doesn't include physical r...

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Injecting meth and missing

Sun, 12 Feb 2017 19:08:45 -0400

Q: I inject meth and have small lump like things from my injection spot to my neck or shoulders.presssure in my head and headaches.is this from a missed shot and where does the fluid go if so?

A: Thanks for writing. It is not unusual to occasionally miss when injecting drugs but this is not a situation to be considered lightly. It is important to initially apply warm compresses and slight pressure to the area, doing so for up to 24 hours. Any meth that didn't get into your bloodstream should be absorbed in about a day.The wound site should be carefully monitored for increased warmth or heat, redness and swelling. These symptoms can develop quickly and the indicate an infection that can r...

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Interactions between ayahuasca and Stribild

Mon, 16 Jan 2017 01:14:46 -0400

Q: Dear David Fawcett PhD, LCSW,I had the most incredible healing experience with Ayahuasca. They recommended to be off any pharmaceuticals before the ceremony.I have been off Stribild since October 30, 2016. My lab numbers have been gradually going down since I have been off Stribild. I would like to get back on Stribild immediately but I am afraid of having a bad experience when I take Ayahuasca medicine next time. Would there be any records of people having bad side effects due the combination o...

A: Hello and thanks for your question. Unfortunately, there is very little research on the interactions between psychedelics and antiretroviral medications. In the United States, research funding has been very limited for recreational drugs in general. Here is a reputable guide to potential interactions between ARVs and recreational drugs, although ayahuasca is not listed. Another psychedelic, LSD...

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I want to take meth for opiate withdraw, also HIV positive

Sun, 08 Jan 2017 16:34:38 -0400

Q: I'm HIV positive and addicted to suboxone. I plan to use crystal meth to get me through the withdraw as this worked for me to get off of methadone a few years ago. I have been taking prednisone 40mg 2 daily for about a year for ulcertive colitis. I can't get off of prednisone because I suffer bad withdraws from it every time I try to lower the dose. QUESTION: I'm going to use the meth to get off suboxone but should I continue to take the prednisone while on the meth or stop taking it? Whats the...

A: Thank you for writing. You describe a scenario full of potentially dangerous complications. I'm not clear why you don't get medical supervision for your withdrawal from suboxone. Methamphetamine is an extremely dangerous drug. Taking it for some kind of assumed therapeutic effect would simply be replacing an opiate addiction potentially with an addiction to stimulants. Keep in mind that if you are taking a booster as part of your HIV-regimen (such as a protease inhibitor), those drugs will aff...

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HIV+ and want to have a baby

Wed, 28 Dec 2016 21:30:42 -0400

Q: Me and my wife are both HIV positive and we want to have a baby what should we do and not do

A: Thanks for writing. There are many options for you to have a baby. This is one article from TheBody's Resource Center for Women which might be helpful. You should also check out the resources section of UCSF's "Hiveonline." They have a great deal of expertise in this area and their site contains multiple resources.It is important ...

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Holy shit I missed

Sun, 04 Dec 2016 15:33:21 -0400

Q: I missed, my vein while shooting meth the redness heat and soreness is continuing to increase what the hell did I do besides medical attention

A: Thanks for writing. If you miss a vein and it continues to swell, get red, or warm/hot to the touch you must seek medical assistance as soon as possible. Life-threatening infections can quickly spread through your bloodstream. Here is a repost of a previous answer on this topic that includes some resoures:http://www.thebody.com/Forums/AIDS/Mental/Q244960.htmlDavid

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Water and needle question - concern about infection

Sun, 04 Dec 2016 15:29:40 -0400

Q: Hi, i recently used a new needle to inject heroin in a restroom. I wiped the sinktop down because theyre was water on it. I placed toillete tissue to lay spoon down to mix heroin in. While mixing the spoon my needle tip briefly touched the counter top, wich was dry but may have had what appeared to be damp water on it. It was for a brief second. I rinsed the needle tip in the sink for a few seconds in the sink before injecting. Am i at risk for hiv/aids?

A: Thanks for writing. The HIV virus is quite fragile outside of its human host, although it can survive briefly in a more liquid setting. I think your chances of acquiring HIV are minimal in the circumstances you described, but your risk for other kinds of bacterial infections is greatly increased.Making your surroundings as antiseptic as possible and using clean works is really essential. guide book fr...

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Hello please

Sun, 13 Nov 2016 16:07:55 -0400

Q: I shoot some math few days ago and hours later my arm was warm to the touch redness and hurt Lil bit to bend its only gettin bigger what do I do someone help please I also think the method had lighter fluid in it way more then it should ever have

A: Thanks for writing. If you miss a vein it is possible at first to apply warm compresses to the injection area. It is important that you watch the area. If it becomes hot to the touch, or red or swollen, it is very important that you get medical attention. Infections can develop that are life-threatening. For other questions please speak with your mental health provider.All the best,David

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