How Do Alcohol and Drugs Affect Your Health If You Have HIV?

Alcohol misuse and illegal substance use (including the misuse of prescription drugs) can affect your brain, making it hard to think clearly. They alter your judgment and lower your inhibition. Below are just some of the ways misuse of alcohol and drugs can affect your health if you have HIV.

Alcohol Misuse and People with HIV

Alcohol misuse means drinking in a manner, situation, amount, or frequency that could harm you or those around you. It includes binge drinking and heavy alcohol use:

• Binge drinking is a pattern of drinking alcohol that brings your blood alcohol concentration, or BAC, to 0.08% or higher. It typically happens if a woman has four or more drinks, or a man has five or more drinks, within about 2 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 alcohol use, for men, is consuming more than four drinks on any day or more than 14 drinks per week. For women, it is consuming more than 3 drinks on any day or more than 7 drinks per week. Binge drinking and heavy alcohol use can increase an individual's risk of alcohol use disorder.

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

Alcohol misuse can harm your health. Your immediate health risks from alcohol misuse include injuries and alcohol poisoning. Alcohol misuse also increases your chances of committing or being a victim of violence. Over time, it can lead to chronic diseases and other serious problems, including high blood pressure, heart disease, stroke, liver disease, digestive problems, psychiatric problems, and cancer of the breast, mouth, throat, esophagus, liver, and colon. For individuals with HIV, heavy alcohol use has been associated with the use of other substances, such as heroin, cocaine, marijuana, and tobacco.

Alcohol misuse can worsen your HIV progression.

Alcohol misuse is dangerous if you have hepatitis B or C and other forms of liver disease because it makes you get sick faster and makes the side effects of your hepatitis treatment worse. Hepatitis B and C can be spread in the same ways as HIV, so people with HIV in the U.S. are often also affected by chronic viral hepatitis.

If you have HIV, alcohol misuse can increase your chances of transmitting HIV because you may be more likely to make decisions that could lead to passing HIV to others. For example, you might have anal or vaginal sex without using HIV prevention tools such as HIV medicine to get and keep an undetectable viral load, or if your HIV-negative partner is not on PrEP. Or you might have a hard time using a condom the right way or share injection drug equipment. Alcohol misuse can also increase your risk of getting or transmitting another STI.

Drug Use and People with HIV

People take drugs illegally to get high. Illegal drug use includes street drugs like heroin, cocaine, or methamphetamine. It also includes prescription drugs used without a prescription or just for the high they cause.

Drug use and addiction can speed up the progression of HIV and its consequences, especially in the brain. It can increase your viral load even if you are adherent to your HIV treatment regimen. Drugs can also make it easier for HIV to enter your brain and trigger an immune response and the release of neurotoxins, which can cause chronic neuroinflammation. Learn more.

If you have HIV, using drugs can cause you to do things that increase your chances of transmitting HIV to others. For example, drugs like methamphetamine, poppers, and ecstasy are linked to having more sex partners or sex without using a condom, both of which increase your chances of transmitting HIV if you are not on HIV medicine to get and keep an undetectable viral load or if your HIV-negative partner is not on PrEP. Like alcohol misuse, drugs can also increase your risk of getting or transmitting other STIs.

If you inject drugs, you are at risk for getting or transmitting HIV and hepatitis B and C if you share or reuse needles, syringes, or other injection equipment ("works") used to prepare drugs. This is because the needles, syringes, or works may have blood in them, and blood can carry HIV. You should not share needles, syringes, or works for injecting silicone, hormones, or steroids for the same reason.

Some people think that using prescription drugs to get high is safer and less addictive than street drugs, but that’s not true. Any form of illegal drug use can lead to abuse and dependence and cause serious and life-threatening side effects or even death.

How Can Alcohol and Drug Use Affect Your HIV Treatment?

If you have HIV, drug and alcohol use can harm your health and affect your HIV treatment in several ways.

Drugs and alcohol can weaken your immune system. HIV damages your immune system, making it harder for your body to fight infections and certain cancers. Drug or alcohol use can further damage your immune system, increasing the chance that you will experience more side effects from your HIV medicines and have a harder time fighting off HIV-related infections. Possible side effects include:

• Lung infections, such as pneumonia, from inhaling certain drugs such as marijuana (pot).
• Dehydration, exhaustion, and skin irritation from using certain drugs such as cocaine or crystal methamphetamine, making it easier for you to get infections.
• Liver damage from excess alcohol use, recreational drugs, and prescription drugs, increasing the risk for chronic liver disease, cancer, and viral hepatitis.
• Greater nerve cell injury and problems with thinking, learning, and memory compared to people with HIV who are non-drug users.
• An increased risk for infections transmitted by blood, including hepatitis B and C, if you inject drugs.

Some recreational drugs can interact with HIV medicines. Drug interactions between HIV medicines and recreational drugs can increase the risk of dangerous side effects. And certain HIV medicines can boost recreational drug levels, leading to dangerously high levels of such drugs in the body, which can cause damage or even death in some cases. That’s why you should always tell your health care provider and pharmacist the truth about what drugs and alcohol you are using.

Drugs and alcohol can affect your ability to stay adherent to your HIV treatment regimen. To be effective, HIV medicine must be taken exactly as prescribed. Using illegal drugs or misusing prescription drugs or alcohol can cause you to forget to take your HIV medicines. That’s a problem because missing doses, even now and then, allows HIV to multiply rapidly. It affects your ability to maintain viral suppression, putting you at risk for opportunistic infections and possibly transmitting HIV to a partner. Drugs and alcohol can also cause you to forget to keep your doctor and clinic appointments and make it hard for you to maintain your house, job, relationships, and social supports—all of which are important for your well-being and sticking to your HIV treatment plan.

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

Choosing to stop using drugs or alcohol is not easy, but it can be done. Quitting will improve your health, well-being, and relationships with others.

Support is available. Many organizations provide hotlines and guidance on substance abuse treatment options:

• Substance Use Treatment Locator (FindTreatment.gov)
• SAMHSA’s National Helpline; Call: 1-800-662-HELP (4357); Text: 435748
• Opioid Treatment Program Directory
• Buprenorphine Treatment Physician Locator
• NIAAA Alcohol Treatment Navigator

Also read the National Institute on Alcohol Abuse and Alcoholism’s Guide for Finding and Getting Help. This guide, written for people who are looking for options to address alcohol problems, helps explain what treatment choices are available and what to consider when selecting among them.