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Mental Health/Substance Use – Signs and Symptoms

Signs and Symptoms

Substance use in People Living with HIV

The signs and symptoms of drug and alcohol use in people living with HIV (PLWHIV) may manifest either as a result of the practice of drug or alcohol use, or medical complications that arise from their use.

Examination findings suggestive of substance use/addiction, or its complications, in PLWHIV include:1

  • general signs
    • detection of alcohol on breath
    • detection of marijuana on clothing
    • detection of nicotine or smoke on breath or clothing
    • poor nutritional status
    • poor personal hygiene
  • behavior:
    • intoxicated behaviour during examination
    • slurred speech
    • staggered gait
    • scratching
  • immune system:
    • swollen/ enlarged lymph nodes (lymphadenopathy)
  • gastrointestinal:
    • enlarged liver (hepatomegaly)
    • liver tenderness
    • blood in the stools (positive stool haemoccult)
  • skin:
    • signs of physical injury
    • bruises/lacerations/scratches/burns
    • needle marks
    • skin abscesses
    • cellulitis
    • jaundice
    • reddening of the palms (palmar erythema) or puffy hands
    • hair loss
    • excess perspiration or sweating (diaphoresis)
    • rash
  • pulmonary:
    • breath sounds (wheezing/rales/snoring-like sound)
    • cough
    • respiratory depression
  • head, eyes, ears, nose, throat:
    • conjunctival irritation or injection
    • inflamed nasal mucosa
    • perforated nasal septum
    • blanched nasal septum
    • sinus tenderness
    • gum disease, gingivitis
    • gingival ulceration
    • rhinitis/ sinusitis
    • pale mucosa of the mouth
    • burns in oral cavity
  • neurological:
    • sensory/memory/motor impairment
    • paralysis/weakness of muscles that control eye movement (ophthalmoplegia)
    • muscle weakness (myopathy)
    • nervous system disorder (neuropathy)
    • tremor
    • cognitive deficits
    • gross lack of co-ordinated muscle movement (ataxia)
    • pupil dilation or constriction
  • cardiovascular:
    • high blood pressure (hypertension)
    • rapid heartbeat (tachycardia) at rest
    • cardiac arrhythmia
    • heart murmurs/clicks
    • oedema/swelling
  • female reproductive/endocrine:
    • pelvic tenderness
    • vaginal discharge
  • male reproductive/endocrine:
    • testicular atrophy
    • penile discharge
    • breast enlargement (gynecomastia)

Co-infections associated with drug use in people living with HIV


  • Tuberculosis is one of the most common HIV-related opportunistic infections in the World Health Organisation (WHO) European region1
    • it is a leading cause of death in PLWHIV1
  • Injecting drug use, alcohol abuse and imprisonment are all risk factors for co-infection with tuberculosis in PLWHIV1
  • Management of tuberculosis in PLWHIV who are injecting drug users (IDUs) is challenging due to:1
    • interactions between tuberculosis drugs and ARVs with illicit drugs and opioid substitution therapy (e.g. methadone)
    • decreased adherence to therapy
    • decreased access to health care systems

Read more about tuberculosis co-infection in PLWHIV. 

Hepatitis C

  • Antibodies to the hepatitis C virus (HCV) are prevalent in 80–90% of IDUs1
  • HCV is easily transmitted among IDUs due to the sharing of needles and other drug taking paraphernalia (e.g. syringes, straws, swabs, cookers), sharing a drug dose from a common syringe, and accidental needle sticks1
    • injecting drug use is the most common route of HCV transmission among HIV-infected people1

Read more about hepatitis C co-infection in PLWHIV.


  1. World Health Organization. HIV/AIDS Treatment and Care. Clinical Protocols for the WHO European Region, 2007. Accessed 25 October 2011.