HIV and illicit drugs are a bad mix. This scientist found an unexpected reason why

It was as a Ph.D. student that Dionna Williams realized the fundamental flaws in how medical science treats people who have HIV and also use illicit drugs or misuse prescription drugs.

People in this group often have worse outcomes than people with HIV who don’t use these drugs. Drug use and addiction have been linked to faster HIV disease progression, a higher viral load and worse symptoms, including brain-related problems.

For years, many doctors and scientists believed these poor outcomes resulted from people not taking the antiretroviral therapies that keep HIV in check, says Williams, a neuroscientist now at Emory University in Atlanta. No one really tested that hypothesis, though — in part because people who report substance abuse had often been excluded from HIV clinical trials.

The argument didn’t make sense to Williams, who met patients with HIV during a summer program while working on their Ph.D. at Albert Einstein College of Medicine in New York City. “Every person with HIV that has a substance use disorder, they can’t just all not be taking their meds. They can’t all just not be going to the doctor. That’s not possible.” Even people who regularly take their antiretroviral medications have bad outcomes if they also use cocaine, for instance. Perhaps there are biological reasons why HIV, its treatments and illicit drugs are such a bad mix, realized Williams, who uses both she and they pronouns. Their career has been dedicated to exploring those connections.

Earlier this year, for example, Williams and colleagues reported in Fluids and Barriers of the CNS, that in human cells in the lab, cocaine increased one anti-HIV medication’s ability to get past the brain’s protective barrier while decreasing the ability for another. The team found that cocaine can also increase amounts of enzymes that are needed to convert the medications to their active forms.

Such findings suggest the problem isn’t always that people who use illicit drugs aren’t taking their prescriptions, but that they may need higher or lower doses or a different treatment.

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