DEBATE DEBATE

Debate on the paper by David Vlahov & David D. Celentano

Debate sobre o artigo de David Vlahov & David D. Celentano

Dirce Bonfim de Lima

Centro Biomédico, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brasil dircebonfim@alternex.com.br

With regard to the use of anti-retroviral medicines (ARV) among illicit drug users, two aspects should be elaborated: adhesion to treatment and medication toxicity. With regard to the problem of adhesion, given the gravity of this application, it calls attention to the enormous difficulty of patients returning for consultations. If we admit that return is difficult, adhesion to treatment becomes unviable. It thus appears impossible for whatever type of user to abide hours and norms of therapeutic conduct (fasting, medicine interaction, number of pills, etc.).

With regard to medication toxicity, the majority of ARV medications are hepatotoxic to a greater or lesser degree. Cocaine and amphetamines have hepatic toxicity, being able to induce fulminant hepatitis with renal insufficiency and rhabdomyolysis. Because of cardiovascular toxicity, it induces hepatic alterations associated with cardiac insufficiency, rendering other medications hepatotoxic ¹.

Chronic consumption of alcohol, which frequently accompanies the use of illicit drugs, can result in alcoholic hepatitis, which induces hepatic deterioration. As such, alterations of the hepatic enzymes in people infected with HIV are frequent, especially with the most potent therapeutic schemes and under the influence of alcohol and other drugs. The prescription of the ARV scheme for this and other special clientele should be considered case by case.

1. Mallat A, Dhumeaux D. Cocaine and the liver. J Hepatol 1991; 12:275-8.