Table 1.

Common legal and illegal drugs and their effect on HIV

	Common adverse clinical consequence of ingestion	Modes of use	Effect on HIV	Evidence-based medication-assisted therapies
Opioids (heroin, morphine, hydromorphone, codeine, poppy straw)	Respiratory depression, coma, overdose; physical and psychological dependence	Injection; inhalation (smoked or snified); oral (synthetic only)	Decreases access to and use of care, decreased prescription of ART, decreased adherence to ART	Methadone (oral); buprenorphine (sublingual); naltrexone (oral, injectable)
Cocaine (white powder, crack)	Agitation, hyperthermia, tachycardia, arrhythmia, hypertension, convulsions, cardiac and CNS disturbances, hallucinations, death, psychological dependence	Injection; inhalation (smoked or snified)	Decreases access to and use of care; decreased prescription of ART; decreased adherence to ART; increased sexual and drug risk behaviours	None
Benzodiazepines	CNS depression, sedation, ataxia, amnesia and coma; deaths are rare when benzodiazepines are taken alone; physical and psychological dependence are rapid and profound	Injection; oral	Associated with increased sexual and drug risk behaviours; decreased adherence to ART; increased STIs	Slow supervised taper and withdrawal needed
Club drugs
Methamphetamine (rINN metamfetamine) and amphetamine-group substances	CNS stimulation; increased alertness and energy; high doses induce euphoria, enhance self-esteem, and increase sexual pleasure; physiologically causes increased heart rate and blood pressure, vasoconstriction (including cerobrovascular events), bronchodilation, and hyperglycaemia; neurotoxic resulting in permanent brain damage	Injection; inhalation; per rectum	Decreases access to and use of care, decreased prescription of ART, decreased adherence to ART	None
MDMA	With overdose: serotonin syndrome, stimulant psychosis, and/or hypertensive crisis, cognitive and memory impairment, acute delirium, cardiac arrhythmias or infarction, coma; profound depression several days after use	Oral (tablet)	Decreased adherence to ART on days of MDMA use	None
Ketamine	Hypertension, cardiac arrhythmias, cognitive impairment	Injection; inhalation (snified or smoked)	Not known	None
Gamma-hydroxybutyrate	Oversedation, coma, death, seizures, hypotension and shock, psychosis and agitation	Oral (liquid)	Not known, but likely similar to alcohol	None
Nitrates/nitrates (poppers)	Methaemoglobinaemia, haemolytic anaemia (especially in those with G6PD deficiency), hypotension, cardiac arrhythmias	Inhalation (liquid)	Assoicated with increased HIV risk behaviours	None
Alcohol	CNS sedation, some malignant diseases, hepatic injury, dietary deficiencies, pancreatitis, gastritis, neurocognitive deficits	Oral	Increases hepatotoxicity; increases peripheral neuropathy; decreases access to and use of care, decreased prescription of ART, decreased adherence to ART	Naltrexone (oral, depot injection); acamprosate; disulfiram

ART=antiretroviral therapy. STIs=sexually transmitted infections. MDMA=methylenedioxymethamphetamine (rINN methylenedioxymethamfetamine). G6PD=glucose-6-phosphate dehydrogenase.