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Increasing use of ‘party drugs’ in people living with HIV on antiretrovirals: a concern for patient safety

Bracchi, Margheritaa; Stuart, Davidb; Castles, Richardc; Khoo, Sayed; Back, Davidd; Boffito, Martaa,b,e

doi: 10.1097/QAD.0000000000000786
Editorial Review

Use of ‘party drugs’, a particular set of recreational drugs used in the context of ‘ChemSex’, is frequent among MSM living with HIV. A recently published observational study showed that more than half of HIV-infected MSM interviewed reported use of illicit substances in the previous 3 months, with frequent concomitant use of three or more drugs. These substances are a combination of ‘club drugs’ (methylenedioxymethamphetamine, gamma-hydroxybutyrate, ketamine, benzodiazepine) and drugs that are more specifically used in a sexualized context (methamphetamine, mephedrone, poppers and erectile dysfunction agents). Although formal data on pharmacokinetic or pharmacodynamic interactions between recreational drugs and antiretroviral agents are lacking, information regarding potentially toxic interactions can be theorized or sometimes conclusions may be drawn from case studies and cohort observational studies. However, the risk of coadministering party drugs and antiretrovirals should not be overestimated. The major risk for a drug–drug interaction is when using ritonavir-boosting or cobicistat-boosting agents, and maybe some nonnucleoside reverse transcriptase inhibitors. Knowledge of the metabolic pathways of ‘party drugs’ may help in advising patients on which illicit substances have a high potential for drug–drug interactions, as this is not the case for all.

aSt Stephen's AIDS Trust

bDean Street Clinic, Chelsea and Westminster Hospital

cJonathan Mann Clinic, Homerton Hospital

dUniversity of Liverpool, Liverpool

eImperial College, London, UK.

Correspondence to Dr Margherita Bracchi, St. Stephen's Centre, 1st floor Research Unit, Chelsea and Westminster Hospital, 369 Fulham Road, London SW10 9NH, UK. Tel: +44 0 20 33156190; fax: +44 0 20 33155628; e-mail: margherita.bracchi@chelwest.nhs.uk

Received 15 April, 2015

Revised 10 June, 2015

Accepted 17 June, 2015

Copyright © 2015 Wolters Kluwer Health, Inc.