The Circuit, HIV and Drugs
The scientific verdict is still out on how dangerous the interaction between HIV medicines and popular "club drugs" may be. But there's enough empirical evidence, both from recreational drug users and doctors, that a protease cocktail does not need an ecstasy chaser.

What is now known is that Norvir and other protease inhibitors reduce the ability of certain enzymes in the liver to break down MDMA (the chemical core of ecstasy), as well as other club drugs. Rather than experience an increased "high," the drugs interaction overloads the body's ability to break down components of recreational drugs. This is particularly acute during the first six weeks of starting certain protease inhibitors, when the amount of medication is elevated in the bloodstream.

While some doctors are flabbergasted at the idea that anyone with a compromised immune system would even think of taking recreational drugs, many in the HIV community are not.

"Certainly the advent of new medication therapies have allowed a person living with HIV and AIDS to enjoy a better quality of life than before; being healthier and potentially more in the "scene" than previously," says Jeffrey Wilkinson, Executive Director of the South Beach AIDS Project.

While there is no hard data about the number of people who are on HIV medications and using club drugs, Wilkinson has heard enough anecdotal stories from people to make him think it is something to be concerned about. In response, his agency created a "Know the Risks" social marketing campaign to get the word out about the dangers of club drugs interacting with HIV medications.

Getting More Than You Bargained For
The problem first came to widespread attention in the late 90s when a man in the U.K. died after he had taken both ecstasy and his regular dose of the protease inhibitor, Norvir (ritonavir, Abbott). Initially it was suspected that the Norvir had somehow super-charged the ecstasy in his bloodstream, so that its effective dosage had been multiplied nearly 22 times.

  Fortunately, death is a rare extreme of the interaction between HIV medications and recreational drugs. Of more concern to health educators is the secondary effects of recreational drug use for people with HIV. There is evidence that most recreational drugs temporarily suppress the immune system in HIV negative people. So people with HIV should be especially cautious.

Plus the "environment" associated with recreational drugs is one that certainly strains the immune system; dancing for hours in hot clubs leads to excessive fluid loss and dehydration. Some protease inhibitors, such as Crixivan (indinavir, Merck) have been linked to the development of kidney stones. All stimulant drugs dehydrate you (especially in combination with alcohol) making frequent water intake extremely important to the proper functioning and health of your kidneys.

Given that many recreational drugs impair focused and logical thinking, it's also easy to forget to take your HIV medicines on schedule. While it may be simple enough to carry HIV medicines with you to work or out to dinner, in the hot, humid environment of a club they will quickly "spoil" as their fragile chemical bonds break down. If a capsule feels at all sticky on the surface, don't take it. If you're out dancing all night, the combination of missed sleep and the normal "post high" depression that follows most recreational drugs, may put you to sleep for hours upon hours -- and when you sleep you don't take your HIV medications. And double dosing to make up in advance for not taking HIV medicines while partying, is a no-no. It may quicken the possible onset of resistance to the medication.

Recreational drugs are also our biggest deterrent to safe sex. If you have HIV and you're flying higher than a 747, you're not going to think about that condom.

It takes a lot of commitment to take HIV medications day in and day out, especially when each dose may be a dozen pills at once. Certainly no one can be blamed for wanting to "let go" and party with club drugs for even just a night. But a bit of fun can lead to a lot of trouble. Are the risks worth it?

Updated: Tuesday, 6 June 2000