Concerning HIV drug resistance fueled by new practice of ‘whoonga’

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    HIV drugs

    HIV drugs are often crushed and mixed with other illicit drugs for smoking (Shutterstock photo)

    A concerning form of drug resistance is developing with two common HIV drugs, though the reason for the resistance is not solely the result of improper dosing or prescribing as it is with many other disease treatments.

    According to a report from NPR, “whoonga,” or the practice of mixing HIV medications and illicit drugs for recreational use, is the new reason HIV drug resistance has popped up in regions like South Africa, where AIDS epidemic is a problem.

    According to experts, HIV drug resistance comes from people who are infected with HIV and have smoked whoonga. They are then more likely to develop a new strain of the virus that becomes immune to the medication. So when they become symptomatic and are in need of the treatment, it does not work for them. This is similar to what happens with most other medications – for example, taking antibiotics when you don’t really need them, increases the likelihood that they won’t combat an infection when there is actual need for it.

    Resistance can also develop from people getting infected with HIV by a person who has smoked whoonga. In these cases, the strain of the virus being transmitted is already immune to the medication.

    Dr. David Grelotti, a Harvard School of Public Health researcher, told NPR, “One large study showed 3 to 5 percent of people with HIV were coming in with pre-treatment resistance. Each time a medication is misused, you assume somebody else is not getting it for appropriate use.”

    Grelotti explained HIV drugs such as Efavirenz or Ritonavir affect the central nervous system, leading to vivid, colorful dreams. In theory, combining the medication with illicit drugs such as heroine, methamphetamine, or marijuana could enhance those substances’ effects. The HIV drugs are commonly crushed and then mixed with their partner substance and smoked.

    dream

    HIV drugs gained popularity in the street drug world because of a tendency to create vivid, colorful dreams when mixed with substances such as heroine and marijuana. (Shutterstock photo)

    Unfortunately, while other medication choices do exist for the treatment of symptoms of HIV, alternatives are not always available in poorer countries. As more and more people use efavirenz and ritonavir for recreational use, the drug’s ability to combat symptoms of HIV becomes diminished and patients begin to show signs of resistance.

    Drug resistance, also known as antimicrobial resistance, is defined by the World Health Organization (WHO) as the process “when microorganisms such as bacteria, viruses, fungi and parasites change in ways that render the medications used to cure the infections they cause ineffective. When the microorganisms become resistant to most antimicrobials they are often referred to as ‘superbugs’. This is a major concern because a resistant infection may kill, can spread to others, and imposes huge costs to individuals and society.”

    Drug resistance can create mutated strains of viruses which then require new or stronger medications to treat. In the case of HIV drug treatment, immunity to current medications will likely result in failed treatment and the need for more costly second-line treatment methods, states WHO.

    Individuals are also at an increased risk because modern HIV treatments have made the public less cautious regarding the disease.

    “There has been a decrease in caution about avoiding HIV infection and an increase in riskier sexual behavior…on the assumption that HIV is much (more) readily treated now,” Dr. Frederick Hecht of San Francisco General Hospital told reporters at a Barcelona conference. “That idea needs to be called into question because some people are becoming infected with (a strain of) virus that is going to be much more difficult to treat.”

    While much of the HIV drug resistance seen has been in high-incidence AIDS areas such as South Africa, experts note the practice of whoonga has been reported in the United States as well, though primarily in jails and with limited use in nightclubs in Miami.

    Despite the lower rate of HIV drug abuse occurrence in the United States, there is still at risk, especially as the number of HIV cases fail to decrease in number. According to the latest statistics released by the Centers for Disease Control, there were approximately 47,500 new HIV infections during 2010, the time from which the most recent data is available.

    Among those new cases, 54 percent of new HIV cases in individuals aged 13-24 years in the U.S. were in patients of African-American descent, and 20 percent were found to be among Latino gay and bisexual young adults.

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