HIV meds and interactions
Combining HIV medication with recreational drugs can lead to dangerous interactions, potentially raising drug levels to fatal extents. Learn about risks and interactions to ensure safer usage.
Overview
If you’re taking chemsex drugs whilst also taking medication for HIV, this can result in interactions that may increase the amounts of drugs in your system to dangerous levels. The University of Liverpool have an HIV drug interactions tool where you can check for any interactions.
Talking to your HIV doctor or pharmacist about this is important so you can get the best advice. During the first four weeks of taking new HIV meds your body is still getting used to them so any potential interactions with drugs you are taking may be at their most intense during this time. You may want to consider taking a break from chems or use a different combination of HIV meds that mean interactions are less likely.
Ritonavir and Cobicistat
The two HIV meds most likely to interact dangerously with recreational drugs are ritonavir (Norvir) and cobicistat (Tybost). Because these both boost the levels of other anti-retrovirals, they can also affect the way recreational drugs are processed. This can cause the recreational drug to stay in the body longer, or be present in larger concentrations which can lead to an overdose.
Ritonavir may be prescribed alongside a protease inhibitor and is also found in the combination pill Kaletra and in the treatment for Hepatitis C, the Viekira Pak.
Cobicistat is found in Stribild – a combination tablet with elvitegravir (Vitekta), tenofovir (Viread) and emtricitabine (FTC). It’s also a component of Prezcobix where it’s combined with darunavir (Prezista), and Evotaz, where it’s combined with atazanavir (Reyataz).
Interactions
Recreational drugs that are most affected by interactions with ritonavir and cobicistat are:
Mephedrone – moderate risk. This is known to have an interaction with ritonavir increasing its concentration in the body.
Crystal meth – moderate risk. When used alongside ritonavir or cobicistat the levels of crystal meth in your blood can double or treble, potentially to fatal levels.
MDMA (Ecstasy) – moderate risk. Ritonavir and cobicistat may increase the levels of concentration of MDMA in your body by up to five or ten times. This is a dangerous combination, and taking a regular dose of MDMA while on ritonavir has been known to cause death. With ecstasy, the risk depends on how much MDMA is contained within the pill, which is impossible to tell. Spacing out when you take MDMA/Ecstasy and HIV meds as much as possible may reduce risk.
Ketamine – high risk. As this is mainly filtered through the liver in the same way as ritonavir and cobicistat, there’s a risk that levels of ketamine in the body can increase.
Erectile dysfunction meds – high risk. When taken with ED meds, levels of these meds can rise three to four times above normal, which can be dangerous for the heart, and also cause damage to the penis.
Benzos (like Valium) – high risk.
For G, the risk of interactions is unknown, but it would be safer to assume that taking ritonavir or cobicistat can boost the levels of G in your body, as per other recreational drugs.
If your HIV meds contain any of the NNRTIs efavirenz (Sustiva), etravirine (Intelence) or neviripine (Viramune), combining these meds with cocaine, ketamine and ED meds can affect the levels of these drugs in your body.