Smoking AIDS

A QUANTUM OF SCIENCE

Anti-retrovirals are now drugs of abuse in South Africa; will this lead to resistant HIV?

The newest chapter in the AIDS saga in Africa is unfolding in the townships of South Africa, where the demographic of 15-21 year olds are engaging in a new practice: grinding up anti-retroviral drugs designed to suppress HIV and prevent it from becoming AIDS, mixing the powder with tobacco or marijuana, and smoking it to achieve hallucinogenic and anxiolytic effects.

A recent BBC article goes into further detail, but mainly focuses on the social aspect of the new form of drug abuse. Doctors and health care policy activists in South Africa are gravely concerned about not only the interruption of the intended use of the drugs - which has led to shortages and long lines in many areas - but also the possibility that this abuse of the drugs will cause resistant strains of HIV to arise.

This seems unlikely for several reasons. First, smoking a pharmaceutical innately changes the molecular structure of the drug. The heat involved might well be expected to break down the structure into inactive forms, or combine key parts of the molecule with oxygen and likewise eliminate its antiviral activity. Without activity, the drug cannot cause resistance to arise. The second reason this fear is ungrounded is that in order to cause resistance, those abusing this drug must also be HIV-positive. While there is likely to be some overlap in a country whose HIV-positive population is 3.2% among that age/sex demographic [LINK], it is unlikely to be enough to cause undue concern from a health policy standpoint.

Clearly there is a health policy crisis in South Africa regarding the proper administration of anti-retroviral drugs. Concerns about drug abuse aside, the phenomenon is preventing those who really need such drugs from obtaining them, and this alone is sufficient reason to take action. But fears of a super-HIV, resistant to the anti-retroviral cocktails of drugs currently capable of controlling (though not eradicating) HIV, are overblown in this case.

© AQOS / Peter Smalley (2009)
Reproduction with attribution is appreciation