A Guide to Primary Care of People with HIV/AIDS - Canadian Public ...

A Guide to Primary Care of People with HIV/AIDS
Chapter 13: Management of Substance Abuse
(ABC) and all the PIs except indinavir (IDV), though
pharmacologically measurable, are not clinically
apparent and standard doses are appropriate. Potential
interactions between illicit drugs and HIV medications
are less well understood. Methamphetamine products
have been associated with sudden death in individuals
on protease inhibitors. Anecdotal reports describe
how selective serotonin reuptake inhibitor (SSRI)
antidepressant medications may produce side effects
that mimic drug withdrawal and may decrease AIDS
medication adherence.
Table 13-7: Antiretroviral Drugs that
Affect Methadone Levels
NRTI NNRTI PI
zidovudine (ZDV) ↔ nevirapine (NVP) ↓ indinavir (IDV) ↔
didanosine (ddI) ↔ delavirdine (DLV) ↑ ritonavir (RTV) ↓
zalcitabine (ddC) ↔ efavirenz (EFV) ↓ nelfinavir (NFV) ↓
Why are HIV and drug abuse both such
noticeable issues now?
HIV and substance abuse are both significant public
health problems that merit the attention of public
health officials and policymakers. Today, an estimated
40 million people worldwide are living with HIV. Of
these, 2 to 3 million people are injection drug users.
In the United States, approximately a third of HIV/
AIDS cases are related to injection drug use. Research
shows that use of drugs, injected or not, can affect
decisionmaking – particularly about engaging in unsafe
sex – that can endanger the health of the drug user
and of others. Substance abuse is a double-edged
sword because it increases an individual’s risks for
continuing drug use while also increasing the likelihood
of exposure to HIV and other bloodborne infections.
Infectious diseases that are more prevalent among
injection drug users than in the general population
are HIV, other STDs, including hepatitis B and C, and
tuberculosis. Prevention and early treatment of drug
abuse and drug-related diseases are critical public
health measures to reduce the spread of new infections.
stavudine (d4T) ↔ saquinavir (SQV) ?
abacavir (ABC) ↓ amprenavir (APV) ↓
lopinavir (LPV)
↓
atazanavir (ATV) ↓
13
↓ = decreases methadone blood levels
↔ = indeterminate effect
↑ = increases methadone blood levels
Source: Adapted from Gourevitch MN, Friedland GH. Interactions
between methadone and medications used to treat HIV infection: a
review. Mt Sinai J Med 2000 67:429-436.
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U.S. Department of Health and Human Services, Health Resources and Services Administration, HIV/AIDS Bureau