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Author Topic: ARV and Recreational Drug Interaction -  (Read 808 times)

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Offline CanadianExpat1983

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ARV and Recreational Drug Interaction -
« on: January 06, 2018, 12:48:50 pm »
Hi there,

I have a question I wasn't able to ask in person due to fear of being judged. I am wondering whether HIV positive males who occasionally use crystal meth are able to remain undetectable while on ARV? The route of administration is rectal and the ARV in use is Genvoya. I understand Cobisistat can potentially lead to overdose or toxicity . However my question is purely on potential loss of therapeutic effects of ARV and drug resistance due to issues rising from drug interaction, absorption, metabolism, liver enzymes and pathways involved. Not in theory but in real life. Assuming 100% adherence with food.

Thank you in advance for your response.

PS This question is not regarding the overall adverse effects of methamphetamine on physical and mental health.

Offline bmancanfly

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Re: ARV and Recreational Drug Interaction -
« Reply #1 on: January 06, 2018, 01:32:51 pm »
Assuming 100% adherence with food.

PS This question is not regarding the overall adverse effects of methamphetamine on physical and mental health.
That's quite the caveat that you threw in at the end of your question. "Other than that Mrs Lincoln, how was the play"  You see the problem with meth is that it often adversely affects adherence and food and all of the other things you need to do to stay healthy so that the meds can help you.  I doubt that you are going to find a specific answer to the question that you are asking.  How would you construct that research study?  "Ok, here's some Tina, smoke it, and let's see how it affects the absorption of your meds".  Seems kinda unethical - don't you think?

I'm not judging your drug use, in the past I've used pretty much every illegal drug that there is out there.  But there is no such thing as a healthy meth user IMHO.  Don't kid yourself that you are the only one, you're not.

Living with HIV is a marathon.  If you want to not only survive but thrive with HIV, then meth can't be a part of that.  Make your own choices, it's your life and you get to live it any way you want.  But I doubt you're going to find the validation of the safety of meth (particularly as it relates to HIV) here.

I had three long term friends with HIV die in the last 24 months.  All of them only in their 50's (which from my vantage point is way too young).  All of them were meth users.  All their death certificates listed one reason or another.  But everyone who knew them understood it was complications from their meth use that ultimately did them in.

"The trouble with the world is that the stupid are cocksure and the intelligent are full of doubt."

 Bertrand Russell

Offline CanadianExpat1983

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Re: ARV and Recreational Drug Interaction -
« Reply #2 on: January 06, 2018, 07:34:50 pm »
There is this below study. However , there are other studies whose finding are quite the opposite. Do we have any treatment providers/pharmacists here on the forum who can share real life observations on the effects of methamphetamine on viral load in the presence of ARV?

"Stimulant use (e.g., methamphetamines) may have less of a negative effect on health outcomes for people living with HIV than previously thought. A team of researchers, in an article published in JAIDS, reported that they found no association between any frequency of stimulant use and mortality, and only a modest association between high-frequency stimulant use and the combined outcomes of mortality and progression to AIDS.

Over 1,000 HIV-positive men who have sex with men participating in the Multicenter AIDS Cohort Study (MACS) provided information for the study about methamphetamine, cocaine, crack cocaine, or ecstasy use. In addition, MACS researchers collected participant data of AIDS-defining illnesses, CD4 cell counts, viral loads, and mortality. On average, participants stayed in the study for about eight and a half years, during which time they completed study visits every three months.

The researchers analyzed participant data to look at the relationship between frequency of stimulant use and the likelihood of progressing to AIDS or dying, while controlling for outside influences such as hepatitis C co-infection, high blood pressure, high cholesterol, depression, drinking, and smoking.

“We thought there would be this dose response relationship where people who had used more often, or reported use more frequently, would have more negative health outcomes. They would die faster, or they would progress to AIDS or die faster,” explains Adam Carrico, PhD, of Department of Community Health Systems, School of Nursing, University of California, San Francisco, and lead author of the paper.

Unexpectedly, they didn’t find a significant association between stimulant use over time and mortality.

“We found that when people are on HAART [highly active antiretroviral therapy], there are not mortality differences between stimulant users and non-users. Being a drug user didn’t mean that you died faster,” says Carrico.

When the researchers considered the combined outcome of progression to AIDS or mortality, they did see evidence of what Carrico explained as a “modest” relationship. People who use stimulants more often (i.e., reported stimulant use at more than half of their visits) displayed increased risk of progressing to AIDS or dying by about 50%. To put this in perspective, this means that—if people who didn’t use stimulants had a 10% likelihood of dying or progressing to AIDS during the study period—using stimulants frequently would increase this likelihood to 15% [editor’s note: the percent chance of mortality or progression to AIDS was not reported in the study].

Carrico explains that although modest, the effect is meaningful. “But it doesn’t mean that there’s this overwhelming effect of stimulant use. That everyone using stimulants is having negative outcomes. And it’s not the occasional user we’re worried about, it’s really people, for example, who meet criteria for treatment at Stonewall [San Francisco AIDS Foundation’s substance use treatment program]. Those are probably the folks that are really having negative health outcomes.”

Independent of drug use frequency, having a higher CD4 cell count when first beginning HAART was protective against mortality. Starting HAART with a CD4 cell count below 200 was associated with over a four-fold increase in the odds of mortality. This was one of the take-away points from the study for Carrico, who notes that, “Using drugs doesn’t mean that you can’t manage your medications, engage in care and talk with your provider about how to get on and stay on HAART. And maximize your adherence. You can manage HIV and stimulant users can do it quite well. A lot of the story is about getting people who use drugs to start HAART. Once people are on treatment, they’re doing pretty well.

Carrico doesn’t mean for people to conclude from the study’s findings that there are no consequences to stimulant use. “There are all sorts of reasons other than HIV to try to think about reducing or abstaining from stimulant use. Exploring ways to reduce or abstain from stimulants can be good for your overall health and well-being. Not just whether you die or develop AIDS.”

Offline JimDublin

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Re: ARV and Recreational Drug Interaction -
« Reply #3 on: January 06, 2018, 08:00:13 pm »
Provide references as in links for any health/medical/scientific information, no need to copy in a whole study.

Look taking meth is not a great move for your health irrespective of your HIV meds or HIV status, and in some small studies it been linked to problems for people with HIV even when taking meds.

Problem with recreational drugs generally speaking is its potential to being an adherence obstacle this is next to in the additional general addiction risk, physical and mental health problems some of drugs pose. Also for illegal drugs not knowing how pure the drugs are or what they exactly contain can be an issue for interactions.

Anyhow focusing on your question, if you are concerned about specific interactions with your HIV meds, than ask your doctor or pharmacist.

Wish you well.

Jim

http://www.positivelite.com/index.php/item/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.

https://www.poz.com/article/meth-disease-25392-7089
Crystal Meth May Fuel HIV Disease Progression and Transmission

Those who used crystal meth had higher cytomegalovirus (CMV) in their semen, tended to have more HIV shedding in their semen and tended to have a worse CD4/CD8 ratio. There was no apparent difference in ARV adherence between those who did or did not use meth.

Compared with the nonusers, meth users had higher levels of activated CD4 cells as well as proliferating CD4 and CD8 cells. Users also had a higher indication of their viral reservoir levels.


https://www.poz.com/article/hiv-crystal-meth-17533-2533
Crystal Meth Accelerates HIV Reproduction

https://www.aidsmap.com/Does-methamphetamine-affect-HIV-viral-load/page/1417142/

https://www.webmd.com/mental-health/addiction/crystal-meth-what-you-should_know



https://forums.poz.com/index.php?topic=9449.0

http://bmjopen.bmj.com/content/7/1/e014105
Recreational drug consumption was found to be related to adherence problems with antiretrovirals

http://www.pharmacytimes.com/resource-centers/hiv/effects-of-recreational-drug-use-in-patients-taking-haart
Clinical pharmacists administered a questionnaire that included sociodemographic variables, past 12-month drug use, adherence to antiretroviral therapy, and high risk sexual behavior.  Overall, 92 of 208 patients reported consuming drugs over the previous year, and 50% reported a relevant interaction with their medications.
« Last Edit: January 06, 2018, 08:35:52 pm by JimDublin »
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Offline CaveyUK

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Re: ARV and Recreational Drug Interaction -
« Reply #4 on: January 07, 2018, 05:28:16 pm »
Yeah as Jim says - theoretically recreational drugs shouldn't be a problem BUT you never quite know what they are cut with, and with longer-lasting/stronger stuff like meth, there are strong correlations with non-adherence.

I did discuss this with my doc following diagnosis (talked about weed and dextroamphetamine, not methamphethamine) and the general message was 'don't do them, but if you do there shouldn't be any issues - just make sure you keep taking your meds and don't take anything habitually'.
HIV - Basics
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Offline CanadianExpat1983

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Re: ARV and Recreational Drug Interaction -
« Reply #5 on: January 10, 2018, 10:37:29 pm »
Thanks guys. I agree with you all. I do it every 3 weeks or longer, never more frequently, however, I keep going back to it regardless. I have decided to seek help and not take any chances with my life any longer.

In the worst case scenario of having developed resistance to Genvoya, what other treatments options will I have?  I am having hard time forgiving myself for repeating the same mistake after only a month of diagnosis and still taking things for granted.

Offline CaveyUK

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Re: ARV and Recreational Drug Interaction -
« Reply #6 on: January 12, 2018, 04:41:33 am »
The only significant risk for you developing resistance is if you have stopped taking your meds whilst on the drugs. If that is not the case, then I wouldn't concern yourself with resistance issues unduly, but just see what your next labs are.

If you have only been diagnosed for a month, then it is really important to ensure you are adhering to the meds and not introducing any elements that may stop you doing that.

If, for some reason, there is some resistance there now, there are lots of different drug options but don't concern yourself with that unless you know there is a problem.
HIV - Basics
HIV 101
You can read more about Transmission and Risks here:
HIV Transmission and Risks
You can read more about Testing here:
HIV Testing
You can read more about Treatment-as-Prevention (TasP) here:
HIV TasP
You can read more about HIV prevention here:
HIV prevention
You can read more about PEP and PrEP here:
PEP and PrEP

 


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