HIV update - 19th August 2015

Recreational drugs and adherence

A new study from the United States suggests that many people living with HIV intentionally miss doses of their HIV treatment when they use recreational drugs or drink alcohol. Many of those in the study were concerned about potential interactions between their HIV treatment, drugs and alcohol.

While in some cases this is a legitimate concern, with a number of drugs there is no evidence of dangerous interactions. A frank discussion with your HIV doctor or your HIV pharmacist is the best way to check.

Taking two or more different drugs together can alter the effect of one or more of the drugs. There are potential interactions between some recreational drugs (including ketamine, ecstasy and crystal meth) and some non-nucleoside reverse-transcriptase inhibitors (NNRTIs) and protease inhibitors (PIs).

But alcohol does not interact with anti-HIV drugs. Some recreational drugs, such as cannabis, only interact with a few anti-HIV drugs. In many cases, you can do more harm by missing doses of HIV treatment than by taking HIV treatment together with alcohol or drugs.

The study recruited over 500 people living with HIV who all used recreational drugs – mostly cannabis and cocaine. A third agreed with the statement “I stop taking my HIV medications when I will be using drugs to get high”. Half of these people also said that they stop taking their HIV treatment when drinking alcohol.

People agreeing with the statement missed more doses than other drug users. They were less likely to have an undetectable viral load.

The researchers say that as well as deliberately missing doses, some people also probably forget to take their HIV treatment because they are drunk, high or otherwise intoxicated.

They say that doctors should talk with their patients about drug use and HIV treatment, in order to address concerns about potential interactions.

There’s more information about drug interactions in NAM’s booklet Taking your HIV treatment.

HIV care after pregnancy

Studies from the United States and South Africa show that many women who attend medical appointments and take HIV treatment while they are pregnant drop out of care soon after the birth of their baby. This can have a negative impact on the women’s own health and potentially also that of their children.

In the American city of Philadelphia, researchers found that only a third of women engaged with HIV care in the three months after the delivery of their baby. A similar number attended HIV appointments in the months that followed.

But those women who did engage with HIV care in the three months after giving birth were much more likely to have an undetectable viral load one and two years later. In other words, women who were able to quickly re-engage with care after giving birth had better results in the long term.

Similarly, in the South African city of Cape Town, 45% of women engaged with HIV care within six months of giving birth and 63% attended appointments three years later. But only a third were consistently engaged with care throughout the period.

Many African countries are now encouraging women who begin HIV treatment during pregnancy to continue to take it for the rest of the lives. But these results suggest that many women find it difficult to continue to attend HIV care on an ongoing basis after the birth of their child.

There are many advantages to continuing to attend HIV medical care after the birth of a child. This includes tests to check that all is well with the baby. Continuing to take HIV treatment will keep the woman well and healthy. This is very important in itself and will also allow her to take good care of her child.

There’s more information in NAM’s booklet HIV and women.


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