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HIV NUTRITION UPDATE
VOLUME 9, ISSUE 1

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Recreational Drug Use And Substance Abuse
Among HIV-Positive People

Substance abuse can play a major role in HIV transmission even among non-injection drug users. The National Institute on Drug Abuse (NIDA) reports increased depression and post-traumatic stress disorder (PTSD) along with substance abuse after the September 11, 2001 attacks. Drug use behaviors that may transmit HIV besides heroin or morphine include the abuse of recreational drugs such as alcohol, methamphetamine (METH), cocaine, crack, marijuana, ecstasy (methylenedioxymeth- amphetamine - MDMA) and other club drugs. Previous issues of the HIV ReSource Review and HIV Nutrition News Update focused on substance abuse, nutritional status and people living with HIV infection (PLWHIV). Recent information from the NIDA highlights factors on the progression to drug dependence.
 
HIV Progression

Numerous studies show that certain substances may hasten the progression of HIV disease. Murine studies show cocaine can enhance the development and progression of AIDS (1) PLWHIV who use morphine, METH or are heavy drinkers may also be hastening HIV disease progression. (2-4)

Alcohol

Alcohol use is associated with high-risk sexual behaviors and injection drug use (IDU). (4) People with alcohol use disorders are more likely than the general population to be HIV-positive. Chronic heavy alcohol use is associated with increased medical and psychiatric complications. Heavy drinking and HIV are associated with delays in seeking treatment, adherence to highly active antiretroviral treatment (HAART) regimens, and poorer HIV treatment outcomes. PLWHIV who are heavy drinkers may be adversely affecting their immune system and central nervous system (CNS) hastening HIV progression. (4) Age appears to affect the brain's ability to recover from alcohol-related damage with more severe and persistent alcohol-related changes seen in the brains of older alcoholics. 
 

 
 
 
"Substance abuse can play a major role in HIV transmission even among non-injection drug users. "
 

 
 
 
 
 
 
 
 
 
 
 
 
 

 

In a preliminary study of 349 people with a history of alcohol problems, those individuals on HAART had higher HIV viral loads and lower CD4 T-cell counts. (5) Although investigators only looked at patients' viral load and CD4 T-cell count on a single day, study results suggest that drinkers may be less likely than nondrinkers to take their medication consistently. In a prospective cohort study of 881 HIV-positive veterans, hazardous and binge drinkers were more likely to have detectable viral loads. (6) Hazardous drinking and alcohol diagnoses were associated with HIV disease progression, liver disease, and/or anemia. Investigators believe health care providers should screen and counsel patients on alcohol issues to not only limit HIV disease progression but lessen liver and bone marrow toxicity as well. (6)

Visit the National Institute on Alcohol Abuse and Alcoholism (NIAAA) web site for resources on alcohol in both English and Spanish. Visit the Alcohol and HIV/AIDS web site is at . View "Alcohol Alert: Alcohol and HIV/AIDS".
 


 
 

 
 
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8/4/2004