Alcohol, Substance Use, and HIV

Content From: HIV.gov•6 min read

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Summary

Using alcohol and other substances, including misusing prescription drugs, can affect your mental health and your judgment, leading to decisions that can increase the risk of transmitting HIV to others.
Substance use can affect your physical health by weakening your immune system, contributing to long-term health problems, and potentially interacting with HIV medicines.
Quitting substance use is hard, but it will improve your long-term health and well-being.

How Does Substance Use Affect Your Health If You Have HIV?

Using alcohol and/or non-medical substances (including the misuse of prescription drugs) can affect your brain, making it hard to think clearly. Substances alter your judgment and lower your inhibition. Below are just some of the ways alcohol and substance use can affect your health if you have HIV.

If you don’t have HIV, learn more about how alcohol use and substance use can affect your risk.

Alcohol and People Living with HIV

Alcohol misuse and illegal substance use can harm your health if you have HIV.

Excessive alcohol use, also called excessive drinking, refers to drinking alcohol in ways that could harm you or those around you. Excessive alcohol use includes the following:

Binge drinking, a pattern of drinking a lot of alcohol in a short amount of time. This typically means four or more drinks for a woman or five or more drinks for a man within about two hours. One drink is a 12-ounce bottle of beer, a 5-ounce glass of wine, or a shot of liquor. Binge drinking can lead to injuries—and even death—from car crashes, falls, medication interactions, and alcohol overdoses.
Heavy drinking, a pattern of drinking a lot of alcohol consistently during a whole day or over the course of a week. This means five or more drinks on any day or 15 or more drinks per week for men. It means four or more drinks on any day or eight or more drinks per week for women.

For people who are younger than the legal drinking age of 21 or for pregnant women, any alcohol use is considered excessive alcohol use.

How Excessive Drinking Affects Your Health

Excessive drinking can harm your health, including worsening the progression of HIV. The immediate health risks from excessive drinking include injuries and alcohol poisoning. Over time, excessive drinking can lead to chronic diseases and other serious health problems.

For people who have hepatitis B or C or other forms of liver disease, excessive drinking is particularly dangerous because it can make someone with liver disease get sick faster and it makes the side effects of hepatitis treatment worse. Hepatitis B and C can be spread in the same ways as HIV, so people living with HIV are often also affected by chronic viral hepatitis.

Excessive Drinking and HIV Transmission

If you have HIV, excessive drinking can lead to decisions that increase the chance of transmitting HIV. For example, you might have sex without taking steps to prevent transmission or you might share injection drug equipment. Excessive drinking can also increase your risk of getting or transmitting another sexually transmitted infection (STI).

Non-Medical Drugs and People Living with HIV

Non-medical drug use (also referred to as substance use) includes non-prescription drugs, like heroin, cocaine, or methamphetamine, as well as prescription drugs used without a prescription or differently than prescribed.

Substance use can worsen the progression of HIV and its consequences, especially in the brain. Some substances can make it easier for HIV to enter the brain and trigger an immune response and the release of neurotoxins, leading to chronic inflammation in the brain. Substance use can also increase your viral load, even if you stick to your HIV treatment regimen as prescribed.

Non-Medical Drug Use and HIV Transmission

If you are living with HIV, substance use can lead to decisions that increase your chances of transmitting HIV to others. For example, methamphetamine, poppers, and ecstasy are linked to sexual behaviors that can increase the risk of transmitting HIV if you are not taking steps to prevent transmission. Like excessive drinking, non-medical drug use can also increase your risk of getting or transmitting other STIs.

For people who inject drugs, sharing or reusing injection drug equipment, like needles or syringes, can increase the risk for transmitting HIV and hepatitis B and C, but there are steps that can reduce the risk.

Some people think that using prescription drugs is safer than using non-prescription drugs, but any form of substance use can lead to SUD and cause serious, life-threatening side effects or even death.

How Can Using Alcohol and Other Substances Affect HIV Treatment?

If you are living with HIV, using alcohol and other substances can harm your health and affect your HIV treatment in several ways.

Immune Function

HIV damages your immune system, making it harder for your body to fight infections and certain cancers. Alcohol and non-medical drug use can further damage your immune system, increasing the chance that you will experience side effects from your HIV medicines and have a harder time fighting off infections. Possible negative health effects include:

Lung infections, such as pneumonia.
Dehydration, exhaustion, and skin irritation that can make it easier to get infections.
Liver damage that increases the risk for chronic liver disease, cancer, and viral hepatitis.
Greater nerve cell injury and problems with thinking, learning, and memory compared to people living with HIV who do not use substances.
An increased risk for infections transmitted through blood, including hepatitis B and C, if you inject drugs.

Drug Interactions

Some non-medical drugs can interact with HIV medicines. Drug interactions between HIV medicines and non-medical drugs can increase the risk of dangerous side effects. Certain HIV medicines can also boost non-medical drugs to dangerously high levels in the body, which can cause damage or even death. Be honest with your health care provider and pharmacist about any substances you use, including alcohol.

Sticking to Your HIV Treatment Regimen

To be effective, HIV medicine must be taken exactly as prescribed. Missing doses, even once in a while, allows HIV to multiply in your body and affects your ability to maintain viral suppression. This puts you at risk for opportunistic infections and increases the chance that you will transmit HIV to a partner. Using alcohol and/or non-medical drugs can make it harder to remember to take your HIV medicines on time and as prescribed. Substance use can also make it harder to keep your health care appointments; stay employed; and maintain your home, relationships, and social supports, all of which are important to help you stick to your HIV treatment plan.

How Can You Find Alcohol or Substance Use Treatment and Support Programs?

Quitting alcohol or substance use will improve your health, well-being, and relationships with others. Choosing to stop using alcohol or other substances is not easy, but support is available to help. Many organizations provide hotlines, guidance, and resources on alcohol and substance use treatment options:

Updated: September 29, 2026