Hi Doctor:

Is it possible to develop drug resistance if exposed to second hand smoke from cigarettes and marijuana? When I go out to clubs on the weekends sometimes, my clothes are smelling of smoke when I get back home. And can you tell me what effect does drinking alcohol have on an HIV+ person?

Use of marijuana and/or alcohol has been associated with lapses in adherence that can lead to drug resistance. Whether second hand marijuana smoke could lead to enough euphoria, impaired judgement, and disinhibition is uncertain, but it might be possible, if the amount that you inhaled was great enough.

80% of people who drink use alcohol in moderation, ie occassionally rather than every day, and in small amounts, ie one or two drinks only. This amount poses no threat to people with HIV, as with people without HIV, and there is some evidence that a single glass of red wine daily has some beneficial health effects.

Recreational drugs - like alcohol and marijuana, and also including uppers, downers, amphetamines (speed or crystal meth), ecstacy, LSD, mescaline, cocaine, and heroine (and others) - get people with HIV into trouble primarily by causing lapses in adherence, which can lead to virologic failure of their regimens and drug resistance. Recreational drugs also get people living with HIV into trouble in the same way that they do for people who are HIV negative, i.e. habitual use can lead to addiction, self destructive behavior, loss of jobs and alienation of loved ones.

There are some other important ways in which individual drugs can seriously impair the health of a person with HIV. For example, alcohol use, even in small amounts, significantly worsens the prognosis of a person with both HIV and hepatitis C. Methadone interacts with some HIV medications, and a higher dose of methadone may be required when a person in a methadone program is started on some ART medications.

I suggest that you talk to your doctor about these habits, and how you are handling them. If you are just dancing and having a good time, and your clothes smell of smoke, the impact on your HIV disease is negligable, and the impact on your general health is a small but real increase in your risk of lung cancer (due to second hand smoke).

If, on the other hand, you are smoking cigarettes, or smoking marijuana, or using alcohol heavily, and/or using other recreational drugs, then you may benefit from some drug counseling and guidance to get you away from that lifestyle, in order to ensure that you stay on top of the best possible self-management of your HIV.

Talk to your doctor, and take this email exchange with you to the visit.