Substance Use and HIV/AIDS

Substance use increases the risk of HIV transmission, and may influence the progression and treatment of HIV infection.Substance use, particularly injection drug use (IDU) with heroin or other drugs, is a major factor in the HIV epidemic, with approximately 25% of infections in the United States occurring in injection drug users. Sexual contacts of injection drug users are also at risk for acquiring HIV infection.

In addition to heroin, other abused substances include cocaine and crack, prescription opioids (e.g. oxycontin), amphetamines (“speed”), crystal methamphetamine (“crystal meth”; "tina"), marijuana, alcohol and sedatives (e.g. benzodiazepines), tobacco, and club drugs such as GHB (“G”), ketamine (“special K”), and MDMA (“ecstasy”). It is important to note that substance users often use more than one drug. Substance users often put themselves at risk by engaging in unsafe sexual practices due to impaired judgement while intoxicated, or in other cases by exchanging sex for drugs.

Crystal methamphetamine deserves specific mention as it is highly addictive and users report a greater number of sexual partners and higher-risk contacts. Crystal meth use is associated with harmful effects on the brain in HIV-infected individuals. Although crystal meth use is geographically widespread, specific populations such as gay men in urban areas, and heterosexual men and women in certain rural areas, have been noted to use crystal meth at higher rates, contributing to increased rates of HIV infection in those populations.

Once a person is HIV positive, substance use continues to play a role in HIV progression, as its use may have harmful effects on a variety of body organs, thus exacerbating the complications of HIV, or making treatment with antiretrovirals more complicated. HIV-infected persons with a history of IDU are commonly co-infected with hepatitis B and/or C virus and may suffer more liver damage. In addition, there may be harmful interactions of recreational drugs including alcohol with the antiretroviral medications. For example, the medical literature reports cases in which the antiretroviral ritonavir likely increased drug levels of ecstasy resulting in toxicity and death. In addition, use of substances may affect one’s ability to adhere to their antiretroviral therapy resulting in HIV treatment failure and development of resistance to the HIV medications.

The treatment of substance use may include a combination of programs, many of which are available at Bellevue Hospital, that treat the physical, social, psychological, and spiritual aspects of addiction. This may involve drug/alcohol detoxification and rehabilitation, 12-step programs (Alcoholics Anonymous/Narcotics Anonymous), and replacement therapy with safer alternatives, such as methadone and buprenorphine for opioid dependence, to reduce drug craving. Methadone and buprenorphine doses may need to be adjusted in patients on antiretroviral medications. Harm reduction is another treatment approach used for substance users, many of whom may not currently be motivated for abstinence. Rather than requiring abstinence, harm reduction emphasizes reducing the potential risks of substance use such as needle-sharing and unsafe sexual activities. Harm reduction counseling is available within Bellevue’s Virology Clinic.

Finally, psychiatric diagnoses are common among HIV infected persons who are substance users. These individuals are referred to as "triple diagnosed patients" when they have HIV, psychiatric illness, and substance abuse concurrently. The range of psychiatric illnesses includes adjustment disorders, anxiety and depressive disorders, bipolar disorder, dementia, and schizophrenia. Mental health providers in the Bellevue Virology Clinic are important members of the medical treatment team for this population of HIV-infected patients.

To get more information about the Harm Reduction Group, the Chemical Dependency Program, or the Detoxification Program, please contact the Bellevue Virology Clinic at 212-562-4038, or click here for more information.