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"Whoonga" Abuse Threatens HIV Patients

Smoking antiretroviral meds mixed with street drugs ("Whoonga") fuels immunity to HIV treatment in South Africa.

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A South African man smoking "Whoonga"
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By May Wilkerson

12/18/12

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"Whoonga" consists of antiretroviral medications mixed with street drugs for recreational use—and its popularity is undermining HIV treatment in South Africa, according to a new report. HIV meds are commonly crushed, combined with illegal drugs and smoked, and this practice causes users to build up an immunity that prevents the drugs from effectively treating HIV. "One large study showed 7 or 8% of people with HIV were coming in with pre-treatment resistance" to antiretroviral drugs, writes Harvard School of Public Health researcher Dr. David Grelotti in the report. Whoonga typically involves drugs like heroin or marijuana along with common HIV medications like efavirenz (sold in the US as Sustiva), which is known to cause vivid and colorful dreams. Another commonly abused antiretroviral drug is ritonavir (brand name Norvir), which is thought to prolong the effects MDMA or ecstasy. Whoonga seems to have become widespread in parts of South Africa around 2010, although recreational use of HIV medications has been documented elsewhere in the world for years. Grelotti hopes that drawing attention to the issue may encourage doctors to consider exploring alternative HIV medications that are less easily abused. In addition to building an immunity, the recreational use of antiretroviral meds represents a waste for patients in poorer countries like South Africa, where these drugs are already in short supply. As Grelotti points out, "each time a medication is misused, you assume somebody else is not getting it for appropriate use."

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