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Recreational Drug Use
Aug 11, 2010

Hello Doctor

A good friend of mine has recently sarted HAART. She has achieved an undetectable viral load within three months and gained 60 t cells so is having a great response.

Recreational drug use has been a regular feature of our group of friends socialising for a number of years. It has never caused any of us any health problems, none of us suffer from addiction and we all have continued to hold down jobs and pass university degrees to a high standard. I would never promote drug taking to other people as I know the effects are different for everyone but I wanted to emphasise that for us it has never been anything more extreme than having a bottle of wine every weekend with friends.

She has been told that there are possible interactions between recreational drugs and medications that we don't know about which could cause adverse reaction and or drug resistance.

However her logic is that if she doesn't miss a dose in 6 months for example, then she can miss a dose one day and have a small amount of mdma or ketamine or a legal high for example without causin any harm. She also said that her Atripla pill is less associated with dangerous increases in blood levels of recreational drugs.

I don't know enough about this to know whether what she is saying is true. She is getting a very strong abstinence message from her doctor. The problem is the same doctor would gave the same message with associated generalised scare stories to an HIV- person. Something we feel can be as counterproductive a harm reduction method as teaching absitinence instead of safer sex to children.

I really do feel though that this is a whole new kettle of fish and not something we can claim to have personal experience of.

We are all there for her and none of our social lives are by no means limited to clubbing. But I guess this is an important part of her life and something which she has fond memories of. I guess it's something like telling a football player they can never kick a ball again. It's not going to kill you and if it keeps you alive then there's no contest. But if there's anyway you can carry on doing it even in a limited way then you're going to do everything to try and do that. I'm worried everything includes kidding herself.

Sorry if this is long winded and I'd just like to stress I'm not promoting recreational drug use to anyone, I have seen it destroy more than one life, my point is just that it's not like that for everyone.

Is she putting herself at serious danger by proposing to miss say 3 doses a year in this fashion?

Thanks so much

Response from Dr. Henry

Separate from the negative health issues of using mdma or ketamine, missing occasional doses of Atripla (missing just 3 doses a year would be considered outstanding adherence)for whatever reason usually doesn't result in failure of the regimen or negative health consequences. KH



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