Smart Highs for Positive Partiers

A Guide for HIV+ Gay Men Who Use Club Drugs

This guide is written for gay men who are HIV-positive and use drugs. It’s about staying healthy while partying. And it covers the effects of recreational drugs on the immune system as well as some of the interactions that can occur between HIV medications and club drugs.

• Tips for staying healthy 
• Do drugs affect the immune system or HIV? 
• Is it HIV or the drugs? 
• HIV medications 
• Viral load and CD4+ tests 
• Drug interactions with Ritonavir 

Tips for staying healthy

• Get lots of rest and eat well before and after partying.
• Stretch a little to prepare your body for drug-induced energy boosts and dance-a-thons.
• Take breaks from dancing to allow your body to relax and cool down.
• Drink a small bottle of water every hour to prevent dehydration.
• Drink lots of water the day after partying to help your body flush out toxins. If you take indinavir (Crixivan), drinking water will reduce your risk of getting kidney stones.
• Avoid mixing recreational drugs, including alcohol. Mixing increases the risk of overdoes, and, the more drugs you take, the harder your liver has to work to remove them from your body.
• Take a multivitamin to help restore your body’s vitamins and minerals.
• Consider that drug use can affect your judgment about taking medication and practicing safer sex.

Do drugs affect the immune system or HIV?

Long-term, heavy alcohol use weakens the immune system. Other drugs may do the same, but more research is needed to know whether they do for sure. It’s also not clear whether drug use causes HIV to progress faster. Here’s what we do know:

• Drug use may increase your chances of getting colds, flu, sore throats and other infections.
• Cocaine, amphetamines (speed) and other drugs decrease your appetite, possibly leading to weight loss.
• Smoking crack can compromise treatment taken to prevent pneumonia.
• Alcohol weakens the effects of some antibiotics and antiviral drugs and may lead to oral candida (thrush).

Given what is known about health problems linked to drug use, it makes sense to use less if possible.

Is it HIV or the drugs?

The symptoms of infections related to HIV can be mistaken for problems caused by drug use, and that confusion can interfere with the early diagnosis of illnesses related to HIV. Try to be open with your doctor to get the most accurate diagnosis possible.

HIV medications

Missing or changing your dose of HIV medication may allow resistance to develop. Resistance means that the virus changes and causes the medication to stop working as it should. If you miss a dose by more than two hours, wait until the next dose to get back on your normal schedule. Don’t take an extra dose to make up for the one you missed. Plan ahead if you’re going to be away from your pills and consider carrying your medications in a pill box.

Partying can interfere with regular eating, and medications meant to be taken with food can be less effective if not taken properly. Not taking medications correctly can also rule out the possibility of using certain medications in the future. If you’re concerned about your treatments, ask your doctor to suggest ways to simplify your medication schedule.

Viral load and CD4+ tests

Having drugs in your system may affect your viral load and CD4+ test results. For the most accurate results, avoid taking drugs the weekend before your test. Most important, be consistent. If you stop using drugs a few days before one test, try doing the same for future tests. That way your results aren’t affected by drug use.

Drug interactions

• We know very little about the interactions between HIV medications and recreational drugs. But we do know that mixing the two can change the effects of the recreational drug and reduce the medication’s effectiveness.
• For example, the group of HIV medications called protease inhibitors (PIs) - ritonavir, indinavir, nelfinavir and saquinavir - affect certain enzymes in the liver. This can cause increased levels of recreational drugs in the body, possibly leading to serious complications.
• Most of the known interactions involve PIs, especially ritonavir. Other PIs don’t seem to affect liver enzymes as much. Still, it’s best to avoid using recreational drugs during the first six to eight weeks of starting any new PI to allow your body to adjust.
• Other medications that affect liver enzymes are the anti-fungal drugs ketoconazole and itraconazole and the newer HIV medications delavirdine and nevirapine. In theory, these medications could interact with recreational drugs. More research is needed to know whether they do for sure.
• People can also react differently to the same drug, depending on their sensitivity or tolerance to the drug, their body size, the amount of drug taken and the presence of other drugs in the system - including alcohol. In other words, interactions between certain HIV medications and street drugs could happen with one person and not with another.
• Also, most recreational drugs, like cocaine and ecstasy, are cut with other substances. As a result, it’s difficult to gauge their purity or quality. Often, it is not the drug that is most harmful to your health but the substances mixed in with that drug.
• If you use recreational drugs or alcohol, the best advice is to start with no more than half of what you would normally take or drink. For example, start with half a tablet of ecstasy then wait an hour to see how it affects you. If the effect is stronger than expected, wait a while before taking the rest or save it for another time.
• Again, it’s hard to predict an interaction between an HIV treatment and a recreational drug. Before starting any new treatment, ask your doctor about side effects and potential drug interactions.

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Drug interactions with Ritonavir*

*The same interactions may occur with other PIs.

DRUG	INTERACTION	EFFECTS	REDUCE THE HARM
Ecstasy/mdma	2- to 10- fold increase of ecstasy levels in the blood.	Causes edginess, increased teeth grinding, joint stiffness, convulsions, dehydration, greater chance of liver and kidney damage.	Divide dose. Take half a tablet. Wait to see what the effects are.
K/ketamine	Increases ketamine levels in the blood.	Causes increased sedation, disorientation and hallucinations. Effects of K may last longer.	Start with half the normal dose. Wait for the effects before taking more.
Speed/ amphetamines	2- to 3- fold increase in amphetamine levels in the blood.	Causes increased anxiety, manic behaviour, racing heart beat, shortness of breath, convulsions and dehydration.	Experiment with lower amounts of the amphetamine. If snorting or injecting, be extra careful.
Viagra	Increases Viagra levels in the blood.	Causes increased side effects such as headache, flushing and high blood pressure.	Viagra should not be taken with poppers or cocaine. Poppers and Viagra together could cause a severe drop in blood pressure and, potentially, a fatal stroke. Unnecessary use of Viagra may lead to permanent problems with erection. Consult a doctor.

This information was provided by the Canadian AIDS Treatment Information Exchange (CATIE).