Living With HIV

What is COVID-19?

COVID-19 is caused by a virus known as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and can be spread from person to person. SARS-CoV-2 is primarily transmitted when a person inhales respiratory droplets or particles that contain the virus or when a person touches their mucous membranes (the moist lining of some organs and body cavities) with hands that have been contaminated with the virus.

What is the connection between COVID-19 and HIV?

Anyone can get infected with SARS-CoV-2 and become severely sick or die from COVID-19. However, people with underlying medical conditions or those who have a weakened immune system are more likely to get very sick, be hospitalized, need intensive care, require a ventilator to breathe, or die from COVID-19.

People with HIV are more likely to have certain underlying medical conditions (known as comorbidities) because human immunodeficiency virus (HIV) weakens the immune system. These comorbidities can cause people with HIV to become severely ill if they get infected with SARS-CoV-2, especially if they have advanced or untreated HIV.

How can people with HIV reduce their risk of getting COVID?

Everyone, including people with HIV, should follow the general CDC protocols on how to protect themselves and others from COVID-19. People with HIV can also protect themselves from COVID-19 by—

• Maintaining a healthy lifestyle
• Continuing to take HIV medicines as prescribed
• Ensuring that their COVID-19 vaccinations are up to date

Should people with HIV get the COVID-19 vaccine?

There are several COVID-19 vaccines that are U.S. Food and Drug Administration (FDA)-approved or authorized for emergency use in the United States. Although people who are vaccinated can still get COVID-19, getting vaccinated decreases the risk of severe illness, hospitalization, and death caused by COVID-19.

CDC recommends that everyone, including people with HIV, get a COVID-19 vaccine. Additional doses of the COVID-19 vaccine may be recommended based on a person’s individual circumstances, like those who are age 65 and older or those who have moderately or severely weakened immune systems due to advanced or untreated HIV.

Although COVID-19 vaccine protection decreases over time, updated COVID-19 vaccines are now available. People who received a COVID-19 vaccine previously should receive the latest COVID-19 vaccine to continue being protected against COVID-19.

Is the COVID-19 vaccine safe for people with HIV?

COVID-19 vaccines are safe for people with HIV. People with HIV were included in COVID-19 vaccine clinical trials. COVID-19 vaccines meet the FDA’s standards of safety, effectiveness, and quality.

According to CDC, there is no evidence that COVID-19 vaccines interfere with medicines to treat or prevent HIV. This means that people with HIV can get the COVID-19 vaccine, and their HIV treatment regimen should continue to work effectively.

What should people with HIV do if they think they may have COVID-19?

People with HIV should follow CDC recommendations regarding symptoms of COVID-19 and get tested immediately. A person can have COVID-19 but show few symptoms or no symptoms at all (also known as asymptomatic infection). Testing is the only way to know that someone has COVID-19.

Most health care providers offer COVID-19 testing. You can also get tested for COVID-19 in the following ways:

• Scheduling an appointment at a pharmacy or medical clinic
• Drive-thru testing at some pharmacies
• At-home rapid tests that are purchased over the counter

Visit the CDC website for more information about self-testing, and visit your state or local health department’s website for information on additional testing sites.

What is the treatment for COVID-19?

Drugs that are FDA-approved or authorized for the treatment of COVID-19 are available for people with HIV. However, some of these approved drugs have drug-drug interactions with certain HIV medicines.

If you have HIV and test positive for COVID-19, you should contact your health care provider, tell them what HIV medicines you are taking, and discuss treatment options. To learn more about drug-drug interactions, read the What is a Drug Interaction HIVinfo fact sheet.

This fact sheet is based on information from the following sources:

From CDC:

• How to Protect Yourself and Others
• Testing for COVID-19
• 5 Things You Should Know About COVID-19 Vaccines
• COVID-19 Vaccines for People Who Are Moderately or Severely Immunocompromised
• Staying Up to Date with COVID-19 Vaccines

From the U.S. Food and Drug Administration:

• At-Home OTC COVID-19 Diagnostic Tests: Frequently Asked Questions

From National Institutes of Health:

• Guidance for COVID-19 and People with HIV (Archived)
• Coronavirus Disease 2019 (COVID-19) Treatment Guidelines (Archived) 

Also see the HIV Source collection of HIV links and resources.

How do people with HIV get displaced?

In the United States, over 1 million people are displaced each year by natural disasters such as earthquakes, floods, hurricanes, tornadoes, tsunamis, and wildfires. From 2008 until 2020, over 9 million people were displaced by floods, storms, and wildfires alone.

Anyone can get displaced by a natural disaster, including people with HIV. While it is unclear exactly how many people with HIV are displaced on an annual basis, one study estimated that approximately 5% to 8% of people with HIV are affected globally by emergencies like natural disasters each year.

How does being displaced affect people with HIV?

For people with HIV, displacement caused by disasters can disrupt access to HIV care, medications, and support services, increasing the risk of potential health complications. These disruptions can make it challenging to stick to a prescribed HIV treatment regimen.

To be effective, HIV medicines must be taken as prescribed, which requires many people to take HIV medicines daily. Interruptions to an HIV treatment regimen can greatly reduce the effectiveness of the medications and may lead to decreased immune function, increased vulnerability to opportunistic infections, and increased risk of HIV transmission.

In addition, interruptions or changes to an HIV treatment regimen can increase the risk of developing drug-resistant HIV. This means that one or more drugs in a person’s HIV treatment regimen will no longer be effective and can limit future HIV treatment options. See the Drug Resistance fact sheet for more information on drug-resistant HIV.

What should someone with HIV do if they get displaced?

People with HIV should make every effort to continue taking their HIV medicines exactly as prescribed if they get displaced by a natural disaster. If possible, displaced people should also attempt to continue attending health care appointments and taking other medications as prescribed to avoid any adverse reactions, even if that means finding a new health care provider.

Whenever possible, it is preferred that people with HIV remain on the same HIV treatment regimen, as long as it has been working effectively. Having the prescription information available to share with a new health care provider in the event of emergency-related displacement can reduce the likelihood of delays in treatment or changes to an HIV treatment regimen.

Aside from having the necessary information and resources noted above, people with HIV who are displaced by a disaster should reach out for assistance as needed. The resources below could help provide support to people in these circumstances:

• Finding a new health care provider: Ryan White HIV/AIDS Program Medical Provider Locator or American Academy of HIV Medicine (if displaced while outside of the United States)
• Getting housing support: FEMA Individuals and Households Program or Housing Opportunities for Persons With AIDS (HOPWA)
• Assistance with HIV medicines: Directory of AIDS Drug Assistance Programs or ASPR Emergency Prescription Assistance Program
• Mental health support: SAMSHA Disaster Distress Helpline
• Transportation services: Ryan White HIV/AIDS Program: Available Care and Services (only available in some areas)

What should someone do if they can’t access HIV treatment while displaced?

In the event that someone with HIV cannot access HIV medicines after being displaced, it is important to restart treatment as soon as possible. Although the virus may temporarily spread, a new HIV treatment regimen will help suppress the virus and return to normal health when access to treatment becomes available. In addition, it can be helpful to temporarily avoid sexual activity to reduce the risk of HIV transmission.

HIV pre-exposure prophylaxis and/or post-exposure prophylaxis can also reduce the likelihood of sexual HIV transmission to a partner if someone with HIV cannot access their normal HIV medicines, though these medicines may also be unavailable in such cases. A health care provider should be able to provide guidance in these situations.

How can people with HIV prepare for emergency displacement?

Given the risks associated with treatment interruptions, it is important for people with HIV to be prepared for potential displacement caused by natural disasters. To help prepare, people with HIV can:

• Pack an Emergency Kit: Create an emergency kit that includes a supply of essential medications (such as a month’s supply of HIV medicines), copies of medical records, and contact information for health care providers. Medical records and provider contact information may be available on an electronic patient portal but usually require an account with login information.
• Plan Ahead: Identify HIV care providers and pharmacies in potential relocation areas. If possible, predetermine a safe place to go in the event of a regional emergency, and evacuate early in the event of an incoming disaster (such as a hurricane). Once the disaster occurs, it can be more difficult to access necessary resources.
• Stay Connected: Maintain communication with health care providers (original and/or new, if applicable) and support networks.

In modern times, many health care organizations offer convenient resources through a patient portal that can be especially valuable in the event of a displacement. These resources often include:

• Brand name(s) and dose(s) of all HIV medicines in the treatment regimen
• Health history including the most recent HIV viral load and CD4 cell count
• Communication tools to change pharmacies or contact the health care provider for questions or concerns

For people who do not have access to a patient portal, the information noted above could be helpful to include in an emergency kit.

This fact sheet is based on information from the following sources:

From the NIH Office of AIDS Research:

• Guidance for Non-HIV-Specialized Providers Caring for People With HIV Who Have Been Displaced by Disasters (Such as a Hurricane)
• Guidelines for the Use of Antiretrovirals in Adults and Adolescents With HIV:
  • Discontinuation or Interruption of Antiretroviral Therapy

From the Administration for Children and Families:

• Human Service Needs and Disaster Displacement: Why Disaster Displacement and Why Now

From Medline Plus:

• Patient Portals – An Online Tool For Your Health

Also see the HIV Source collection of HIV links and resources.

What are dietary supplements?

Dietary supplements are manufactured products that are typically used to improve some aspect of health. Depending on the main ingredient, dietary supplements can come in different forms, including tablets, capsules, gels, liquids, powders, and gummies.

Dietary supplements are often found in the foods that we eat. However, supplements can sometimes be more convenient to consume to avoid any concerns related to preparing foods, planning meals, eating certain foods often enough, or worrying about food spoiling. Types of dietary supplements include vitamins, minerals, botanicals/herbs, botanical compounds, microbials, and amino acids. Some examples include:

• Vitamins: Vitamin A, vitamin C, vitamin E
• Minerals: Calcium, zinc, iron
• Botanicals/herbs: Echinacea, oregano, turmeric
• Botanical compounds: Caffeine, CoQ10, curcumin
• Live microbials: Probiotics
• Amino acids: Branched chain amino acids, essential amino acids, glutamine, leucine

Most people take dietary supplements based on the proposed benefits of that specific supplement. For example, calcium supplements are often used to help build strong bones. However, some supplements may not be as effective as they are claimed to be. The NIH Dietary Supplement Fact Sheets can provide information on supplements to determine if they are worth taking.

Note: While the U.S. Food and Drug Administration (FDA) helps regulate dietary supplements, it does not review and approve these products for safety or effectiveness before they become available to consumers. Due to the lack of regulatory requirements needed for dietary supplements to get approved for purchase, additional steps may be necessary to help reduce the risks associated with unsafe products.

To help choose safe and reliable dietary supplements, consumers should look for supplements with a seal from a third-party organization like the National Sanitation Foundation or The United States Pharmacopeial Convention, which test products to confirm the legitimacy of the contents. Because the FDA helps regulate dietary supplements only after they are available for purchase, it is also a good idea to choose products or brands with a proven history.

What dietary supplements should you take if you have HIV?

Generally, dietary supplements should be used to supplement a lack of certain nutrients in your diet or to accommodate your specific health needs. This means that the need for any dietary supplements should be determined on a case-by-case basis and in consultation with your health care provider, regardless of your HIV status.

However, if you have HIV, you may be more likely to experience certain symptoms or side effects related to HIV or antiretroviral therapy (ART). Examples of symptoms or side effects include rash, diarrhea, fatigue, and depression. In addition, if you are pregnant and have HIV, you may be more likely to experience preterm delivery and have an infant with low birth weight.

Some dietary supplements have been researched specifically on people with HIV, including:

• Curcumin: May reduce some symptoms (such as diarrhea)
• Folate: May reduce the chances of having a preterm birth
• N-acetylcysteine and glutathione: Unlikely to make big changes to HIV-related outcomes
• Selenium: May reduce the risk of preterm delivery during pregnancy
• Vitamin A: May reduce some symptoms (such as diarrhea) and improve survival of infants with HIV; may reduce the risk of serious illness during pregnancy
• Vitamin D: Unlikely to make big changes to HIV-related outcomes
• Zinc: Can possibly improve general health and reduce the risk of some symptoms (such as diarrhea), but results are inconclusive

While specific research on people with HIV may not be available, some research supports the use of dietary supplements for health concerns that are more common in people with HIV. Examples include:

• Reduced bone density: Calcium, vitamin D
• Skin rash: Omega-3 oils (fish oils), vitamin E
• Stomach discomfort: Probiotics
• Weight gain: Caffeine
• Weight loss: Protein and/or amino acids

While it is possible that a dietary supplement may help if you are experiencing these symptoms or side effects, it is important to consult with a health care provider before taking any dietary supplements because some products may interact with HIV medicines.

How are dietary supplements different if you have HIV?

If you have HIV, dietary supplements may help with specific health concerns caused by HIV infection or HIV medicines. These supplements can potentially reduce the frequency or severity of issues like weakened immune function, weaker bones, liver or kidney problems, digestive problems, mental health challenges, and some nutrient deficiencies that are caused by HIV or HIV medicines.

Although dietary supplements can sometimes improve HIV-related symptoms, some HIV medicines can cause or amplify certain health issues. For example, tenofovir disoproxil fumarate (TDF) has been linked to bone and kidney issues, and HIV medicines in the integrase strand transfer inhibitor (INSTI) class may cause issues with the absorption of minerals like calcium and iron.

In addition, if you have HIV and also take medicines for other health concerns (such as heart disease), the combination of medicines can further complicate how dietary supplements affect the body. Because some dietary supplements can cause drug interactions with HIV medicines or other medicines, it is important to consult with a health care provider before taking a new supplement.

What dietary supplements should you avoid if you have HIV?

The dietary supplements you need vary based on your unique circumstances, including factors like overall health, HIV medicines, other medicines, and diet. These factors can influence which dietary supplements are safe and which should be avoided.

Even so, some dietary supplements have documented interactions with HIV medicines and should be avoided. Some dietary supplements that may cause serious drug interactions include:

• Cations (such as calcium, magnesium, aluminum): May reduce the effectiveness of HIV medicines in the INSTI drug class
• Probiotics: May cause gastrointestinal issues
• St John’s Wort: May interact with HIV medicines in the protease inhibitor and non-nucleoside reverse transcriptase inhibitor drug classes
• Vitamin A: May cause liver problems when combined with some medicines or in high doses

It is important to consider that some supplements may include these ingredients, although they aren’t explicitly listed on the front label.

For example, some “super green” supplements contain high levels of vitamin A, and some antacids (such as Tums) include high levels of cations. See the HIVinfo What is a Drug Interaction? fact sheet for more information about drug interactions.

What are some tips for taking dietary supplements if you have HIV?

Dietary supplements may help improve certain aspects of your health when taken as intended. If you have HIV, the first step to take before taking a dietary supplement should be to consult with a health care provider to make sure it is safe based on your personal situation.

Otherwise, to get the most out of a dietary supplement, it is important to be mindful of how the supplement is taken. Some tips for taking dietary supplements include:

• Reading labels: Some supplements may have additional instructions or information (such as allergens) that could be important to know.
• Planning around meals: Some supplements may need to be taken with food, while others should be taken on an empty stomach.
• Scheduling intake: Taking a supplement too frequently or infrequently can impact the effectiveness or safety.
• Taking recommended doses: Doses that are too big or small can impact the effectiveness or safety.
• Monitoring effects: Being aware of a supplement’s effects on the body after taking it can help prevent long-term problems.

If you have HIV and plan to take a dietary supplement, being mindful of these tips can help ensure a supplement is both safe and effective. 

This fact sheet is based on information from the following sources:

From the U.S. Food and Drug Administration:

• FDA 101: Dietary Supplements
• Mixing Medications and Dietary Supplements Can Endanger Your Health

From the NIH Office of Dietary Supplements:

• Dietary Supplements for Immune Function and Infectious Diseases
• Dietary Supplements: What You Need to Know
• Dietary Supplement Fact Sheets

From the HIV Clinical Practice Guidelines at Clinicalinfo.HIV.gov:

• Guidelines for the Use of Antiretrovirals in Adults and Adolescents With HIV:
  • Adverse Effects of Antiretroviral Agents
  • Drug-Drug Interactions

Also see the HIV Source collection of HIV links and resources.

What is mental health?

Mental health refers to a person's overall emotional, psychological, and social well-being. Mental health affects how people think, feel, and act.

Good mental health helps people make healthy choices, reach personal goals, develop healthy relationships, and cope with stress. In contrast, poor mental health means people find it difficult to manage how they feel, think, act, or cope with stress.

Poor mental health is not the same as mental illness (also known as a mental disorder). Mental illnesses are diagnosed mental, behavioral, or emotional disorders that can vary in severity and may impact different areas of life, including jobs and relationships. 

Mental illnesses include many different conditions, such as anxiety disorders, mood disorders (such as depression), eating disorders, post-traumatic stress disorder (PTSD), bipolar disorder, attention deficit hyperactivity disorder (ADHD), autism spectrum disorder, and schizophrenia.

A person can have poor mental health and not have a diagnosed mental illness. Likewise, a person with a mental illness can still enjoy good mental well-being. While there are some differences between poor mental health and mental illnesses, they will be referred to collectively as mental health conditions throughout this fact sheet.

If you are living with HIV, it is important to take care of both your physical and mental health.

Are people with HIV at risk for mental health conditions?

Mental health conditions are common in the United States. Anyone can experience poor mental health or a mental health illness. According to the National Institute of Mental Health (NIMH), about one in five American adults lived with a mental illness in 2021.

People with HIV are at high risk of some mental health conditions because of HIV-related stress. For example, people with HIV are twice as likely to have depression as people who do not have HIV.

It is important to remember that mental health conditions are treatable and that people can recover from poor mental health.

What can cause mental health conditions in people with HIV?

The following factors can increase the risk of mental health conditions in anyone, including people without HIV:

• Major life changes, such as the death of a loved one or the loss of a job
• Negative life experiences, such as abuse or trauma
• Biological factors, such as genes or brain chemistry
• A family history of mental health conditions

In addition to these factors, the stress of having a serious medical illness or condition, like HIV, may also negatively affect a person's mental health. Situations that can contribute to mental health conditions in people with HIV include:

• Difficulty in telling others about an HIV diagnosis
• Stigma and discrimination associated with HIV
• Loss of social support and isolation
• Difficulty in getting mental health services

In people with HIV, both HIV infection and related opportunistic infections can affect the brain and the rest of the nervous system. This may lead to changes in how a person thinks and behaves. 

In addition, some medicines used to treat HIV may have side effects that affect a person's mental health. For example, doravirine has been linked to depression and sleep disturbances in some people. 

However, side effects from HIV medicines that affect mental health can usually be fixed by changing HIV medicines. Be sure to talk to your doctor if you think your HIV medicine is affecting your mental health.

What are the warning signs of a mental health condition?

Changes in how a person feels or acts can be a warning sign of a mental health condition. For example, potential signs of depression include:

• Losing interest in activities that are usually enjoyable
• Experiencing persistent sadness or feeling empty
• Feeling anxious or stressed
• Having suicidal thoughts

If you have any signs of a mental health condition, it is important to get help. You can reach out to the Substance Abuse and Mental Health Services Administration (SAMHSA) hotline for immediate help.

What should people with HIV do if they need help for a mental health condition?

People with HIV can talk to their health care provider about how they are feeling. They can also tell their health care provider if they are having any problems with drugs or alcohol, which can also impact mental health.

Health care providers will consider whether any HIV medicines may be affecting the person’s mental health. They can also help people with HIV find a mental health care provider, such as a psychiatrist or therapist.

Here are additional ways that people with HIV can improve their mental health:

• Join a support group
• Try meditation, yoga, or deep breathing to relax
• Get enough sleep, eat healthy meals, and stay physically active

To find mental health treatment services, use these resources from the NIMH and the SAMHSA.

This fact sheet is based on information from the following sources:

From the Centers for Disease Control and Prevention:

• About Mental Health
• Stigma and HIV

From Medline Plus:

• Mental Disorders

From the NIMH:

• HIV and AIDS and Mental Health
• Mental Illness

From SAMHSA:

• What Is Mental Health?

From the U.S. Department of Veterans Affairs:

• Mental Health and HIV

From the World Health Organization

• Mental Disorders

Also see the HIV Source collection of HIV links and resources.

Why is good nutrition important for people with HIV?

Good nutrition is about finding and maintaining a healthy eating style that provides essential nutrients. Eating well supports overall health and helps maintain good immune function.

For people with HIV, taking HIV medicines (known as antiretroviral therapy) helps protect the immune system from damage. A healthy, nutritious diet can help the body process HIV medicines effectively, support immune health, and improve overall well-being.

HIV and some HIV medicines are associated with heart disease and risk factors related to heart disease, such as high body weight. Good nutrition is a safe and effective way to help prevent heart disease or weight gain. However, supportive medicines, such as statins, are often recommended for people with HIV to help maintain heart health.

For more information on heart disease and weight gain in people with HIV, see the HIVinfo HIV and Heart Disease and HIV and Lipodystrophy fact sheets.

What is a healthy diet for people with HIV?

The basics of a healthy diet are the same for everyone, regardless of HIV status. Some general recommendations include—

• Eating a variety of foods from the five food groups: fruits, vegetables, grains, proteins, and dairy
• Eating the right amount of food (measured in calories) to maintain a healthy weight
• Choosing foods low in saturated fat, sodium (salt), and added sugars

To learn more about healthy eating, visit the U.S. Department of Agriculture’s (USDA’s) MyPlate.gov website.

In some cases, people with HIV may benefit from using dietary supplements in addition to a healthy diet. See the HIV and Dietary Supplements fact sheet for more information.

Can HIV or HIV medicines cause nutrition-related problems?

HIV and HIV medicines can sometimes cause nutrition-related problems. For example, some HIV-related infections can make it hard to eat or swallow. Side effects from HIV medicines, such as loss of appetite, nausea, or diarrhea, can also make it hard to stick to an HIV regimen. 

If you have HIV and are having a nutrition-related problem, talk to your health care provider. Otherwise, to avoid nutrition-related problems, people with HIV must also pay attention to food safety.

What is food safety?

Food and water can be contaminated with germs that cause illnesses (called foodborne illnesses or food poisoning). Food safety is based on how to select, handle, prepare, and store food to prevent foodborne illnesses. For instance, the U.S. Food and Drug Administration (FDA) provides guidelines on the minimum food temperatures to use when cooking to prevent foodborne illnesses.

Water quality is also important because most people drink and cook with water. While there are many regulations in the United States to help make sure people have access to clean water, it’s important to read local water quality reports and to test your own water supply to make sure you aren’t consuming harmful germs or chemicals.

Because HIV damages the immune system, foodborne illnesses are more likely to be more serious and last longer in people with HIV than in people without HIV. Following food safety guidelines reduces the risk of foodborne illnesses.

What steps can people with HIV take to prevent foodborne illnesses?

If you have HIV, follow these food safety guidelines to reduce your risk of foodborne illnesses:

Do not eat or drink the following foods:

• Raw eggs or foods that contain raw eggs, such as homemade cookie dough
• Raw or undercooked poultry, meat, and seafood
• Milk, dairy products, and fruit juices that are unpasteurized

Follow the four basic steps to food safety: clean, separate, cook, and chill:

• Clean: Wash your hands, cooking utensils, and countertops often when preparing food.
• Separate: Separate foods to prevent the spread of any germs from one food to another. For example, keep raw meat, poultry, seafood, and eggs separate from foods that are ready to eat, including fruits, vegetables, and breads.
• Cook: Use a food thermometer to make sure that foods are cooked to safe temperatures (see the FDA’s Safe Minimal Internal Temperature Chart).
• Chill: Refrigerate or freeze meat, poultry, eggs, seafood, or other foods that are likely to spoil within 2 hours of cooking or purchasing.

For more information, visit the FDA’s Food Safety for Older Adults and People with Cancer, Diabetes, HIV/AIDS, Organ Transplants, and Autoimmune Diseases webpage. If you are planning a trip outside the United States, read the Centers for Disease Control and Prevention’s (CDC’s) recommendations on Food and Drink Considerations When Traveling.

This fact sheet is based on information from the following sources:

From the CDC:

• Living With HIV
• Water Quality and Your Health

From the Health Resources and Services Administration:

• Guide for HIV/AIDS Clinical Care: Nutrition

From the HIV Clinical Practice Guidelines at Clinicalinfo.HIV.gov:

• Statin Therapy in People With HIV

From the U.S. Department of Veterans Affairs:

• HIV: Nutrition and Exercise

From the USDA:

• MyPlate.gov

Also see the HIV Source collection of HIV links and resources.

What is the connection between HIV and substance use?

Substance use refers to the use of recreational drugs and alcohol, as well as the misuse of prescription drugs and over-the-counter medicines. Examples of each of these substances include:

• Alcohol: Beer, wine, and liquor
• Recreational drugs: Opioids (such as heroin), methamphetamine (meth), cocaine, and inhalants (poppers)
• Prescription drugs: Stimulants (such as Adderall), depressants (such as Xanax), opioid painkillers (such as Vicodin), and sleep medicines (such as Ambien)
• Over-the-counter medicines: Cough medicine and laxatives (for weight loss)

Substance use is related to HIV in the following ways:

• Use of alcohol and recreational drugs can lead to less safe behaviors that increase the chances of getting HIV or passing it on to others (called HIV transmission).
• Some prescription drugs and over-the-counter medicines can also lead to less safe behaviors when misused, including stimulants and opioid painkillers.
• The use of recreational drugs and alcohol can weaken the immune system and damage the liver.

How does substance use increase the risk of HIV transmission?

Drug and alcohol use affect the brain (including memory, attention, and reasoning) and impair clear thinking and decision-making, which may lead to behaviors that increase the chances of getting HIV.

Like drugs and alcohol, using prescription drugs and over-the-counter medicines for purposes other than prescribed, in excessive amounts, or over a longer period than necessary can affect thinking and decision-making.

Some behaviors can increase the chances of getting or transmitting HIV. For example, a person using drugs or alcohol may have sex without a condom or share needles when injecting drugs.

In the United States, HIV is spread mainly by—

• Having anal or vaginal sex with someone who has HIV without using a condom or taking medicines to prevent or treat HIV
• Sharing injection drug equipment (works), such as needles, with someone who has HIV

Using or misusing substances can make people more likely to engage in these behaviors. For someone with HIV, this increases the risk of passing it to others. For someone without HIV, it increases their chances of getting HIV.

In addition, using or misusing substances can increase the risk of other sexually transmitted infections (STIs), not just HIV. See the HIV and Sexually Transmitted Infections fact sheet for more information.

How can substance use affect a person with HIV?

Substance use can harm the health of a person with HIV in several ways, including poorer immune function, reduced liver function, or interactions between substances and HIV medicines, known as drug interactions.

Drugs, Alcohol, and the Immune System

HIV damages the immune system, making it harder for the body to fight infections and certain cancers. Although HIV medicines help to promote good immune function, drugs and alcohol can counteract those effects.

If damage to the immune system gets worse or continues for a long time, a person with HIV may become more vulnerable to opportunistic infections. See the HIVinfo What is an Opportunistic Infection? fact sheet for more information.

Drugs, Alcohol, and Liver Damage

One of the main functions of the liver is to remove harmful substances (toxins) from the blood. Toxins are produced when the liver breaks down the chemicals in drugs or alcohol.

Drug and alcohol use can damage the liver, making it harder to remove toxins from the body. The buildup of toxins can weaken the body and lead to liver disease, including hepatotoxicity. See the HIVinfo HIV and Hepatotoxicity fact sheet for more information.

Interactions With HIV Medicines

Drug interactions between HIV medicines and recreational drugs can increase the risk of dangerous side effects. For example, overdoses have been linked to interactions between some HIV medicines and recreational drugs, such as ecstasy (MDMA) or painkillers.

Some prescription drugs can also have dangerous interactions with HIV medicines, especially if used in excess. This is particularly true for some HIV medicines in the protease inhibitor class. A health care provider can make sure combinations of medicines (such as HIV and anti-anxiety medicines) are safe when taken as prescribed.

Drug, Alcohol, and Medicine Consistency

People with HIV take a combination of HIV medicines (called an HIV treatment regimen) on a strict schedule. Drug or alcohol use can make it hard to focus and stick to an HIV treatment regimen. Skipping HIV medicines allows HIV to multiply and damage the immune system.

Who is most likely to be affected by substance use and HIV?

Although HIV and substance use can affect anyone, research shows that some people have increased chances of engaging in substance use and/or getting HIV. Examples include those who—

• Are adolescents and young adults (aged 13 to 24 years)
• Have mental health disorders
• Do not have consistent housing
• Have been to or remain in jail or prison
• Are men who have sex with men
• Exchange sex for money
• Inject drugs

Understanding who may be more affected helps support prevention efforts and connect people to treatment.

What steps can you take to reduce health risks from substance use?

If you or a sexual partner uses drugs or alcohol—

• Do not have sex if you or a sexual partner is under the influence of drugs or alcohol.
• Use a condom correctly every time you have sex. Read this fact sheet from the Centers for Disease Control and Prevention (CDC) on how to use a condom correctly.

If you drink alcohol—

• Drink in moderation. Moderate drinking is up to one drink per day for women and up to two drinks per day for men. One drink is a 12-oz bottle of beer, a 5-oz glass of wine, or a 1.5-oz shot of liquor.
• Visit Rethinking Drinking, a website from the National Institute on Alcohol Abuse and Alcoholism (NIAAA). This website can help you evaluate your drinking habits and consider how alcohol may be affecting your health.

If you inject drugs—

• Use only new, sterile needles and drug injection equipment (works) each time you inject.
• Never share needles and works. Syringe Service Programs may help provide resources to people who inject drugs.
• Visit CDC’s webpage on injection drug use for more information on how to reduce the risk of getting or transmitting HIV from injection drug use.

If a sexual partner injects drugs—

• Encourage them to get tested for HIV regularly (such as every 3 months).
• Be sure they have not shared a needle with anyone else before you have sex. Always use a condom regardless of their response.
• Consider taking pre-exposure prophylaxis (PrEP) in case they unknowingly get HIV.

Therapy, medicines, and other methods are also available to help you stop or cut down on drinking alcohol or using drugs. You can talk with a counselor or a health care provider about options that might be right for you.

To find a substance abuse treatment center near you, visit the Substance Abuse and Mental Health Services Administration’s treatment locator or call 1-800-662-HELP (4357).

What should you do if exposed to HIV from substance use?

People who are taking PrEP when they are exposed to HIV may not need to do anything else as long as they have been taking their PrEP exactly as prescribed. However, they should continue their regular PrEP schedule and follow routine HIV testing as recommended by their health care provider.

If you are not on PrEP or have missed doses, postexposure prophylaxis (PEP) should be started as soon as possible after exposure—within 72 hours (3 days) of exposure. If PEP was not started within 72 hours of exposure, it is best to get tested for HIV.

No HIV test can detect HIV immediately after exposure. The window period, or time between HIV exposure and when a test can detect HIV, varies from 10 to 90 days depending on the type of HIV test used. Your health care provider can help schedule an HIV test based on the type of test they use.

This fact sheet is based on information from the following sources:

From CDC:

• HIV Outbreaks Among People Experiencing Homelessness and Housing Instability
• Infectious Diseases in Persons Who Inject Drugs
• Substance Use Among Youth
• Substance Use and Sexual Risk Behaviors
• Preventing HIV

From the HIV Clinical Practice Guidelines at Clinicalinfo.HIV.gov: 

• Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents With HIV:
  • Substance Use Disorders and HIV

From the Department of Veterans Affairs:

• Drugs, Alcohol, and HIV

From the Department of Health and Human Services, Office of Disease Prevention and Health Promotion:

• 2015 – 2020 Dietary Guidelines for Americans: Appendix 9. Alcohol

From HIV.gov:

• Substance Use and HIV Risk

From the National Cancer Institute:

• Substance Abuse 

From the National Institute on Drug Abuse (NIDA):

• Misuse of Prescription Drugs Research Report: Overview
• Over-the-Counter Medicines Drug Facts

From the Substance Abuse and Mental Health Services Administration:

• Chronic Substance Use and Cognitive Effects on the Brain: An Introduction
• Co-Occurring Disorders and Other Health Conditions

Also see the HIV Source collection of HIV links and resources.

Can people with HIV get a transplant?

While there are some limitations, people with HIV can get a transplant, including both solid organ transplant (SOT) and hematopoietic cell transplant (HCT). With modern HIV medicines, transplants are relatively common and safe for people with HIV under normal circumstances.

In fact, some evidence suggests that allogeneic HCT can reduce the amount of HIV in recipients with certain donors. In contrast, people with HIV may be less likely to get referred for transplant if they also have end-stage renal disease (ESRD), even though kidney transplant appears to be more effective than dialysis for people with HIV and ESRD.

Can people with HIV donate organs?

As of 2013, people with HIV can donate organs in the United States as a result of the HIV Organ Policy Equity (HOPE) Act. However, organs donated from people with HIV can only be provided to recipients who also have HIV. By donating organs, people with HIV can help ensure that other people with HIV have organs available if needed. 

To support improved access to transplants in alignment with the HOPE Act, the U.S. Department of Health and Human Services amended the requirements for clinical trial enrollment or Institutional Review Board approval for transplants in people with HIV, further enhancing access to these services.

People with HIV and other opportunistic infections (such as viral hepatitis) may not be eligible to donate organs. In addition, organ donors with HIV should be screened for drug resistance to HIV medicines to make sure HIV treatment will continue to be successful for the transplant recipient.

How is a transplant different for people with HIV?

Transplant can be different for people with HIV whether serving as a donor or recipient. For both recipients and donors, additional testing may be necessary to ensure safety both before (such as drug resistance testing) and after (such as kidney or liver function) transplant.

In addition, health care providers must rigorously review both HIV and non-HIV medicines before transplant. In some cases, changes to HIV medicines may be necessary. However, these changes should allow people with HIV to continue taking their HIV medicines to maintain adequate immune function before and after transplant, whenever possible.

Before a transplant, health care providers should ensure people with HIV have maintained HIV viral suppression, meaning that the levels of HIV in the blood are undetectable. This allows the immune system to function properly by protecting the body’s infection-fighting CD4 cells (CD4 T lymphocytes).

Because people who receive transplants are likely to experience significantly reduced immune function (called immunosuppression), health care providers should continue monitoring viral suppression after the transplant occurs.

Can people with HIV and viral hepatitis get a transplant?

While people with HIV can get or receive a transplant, health care providers often test for opportunistic infections like hepatitis B virus (HBV) and hepatitis C virus (HCV) before referring someone for a transplant. In general, these forms of hepatitis are more common in people with HIV, making them more important to consider due to potential health implications.

People with HIV and viral hepatitis can still receive a transplant but should follow specific medication guidelines; people with HBV should take an anti-HBV medicine (such as tenofovir alafenamide or entecavir) whereas people with HCV should be treated with direct-acting antivirals. Of note, transplant eligibility may be more dependent on the organ being transplanted in people with HIV and viral hepatitis.

What are the main considerations for transplants in people with HIV?

People with HIV require some special considerations before donating or receiving a transplant. For donors with HIV, considerations include evaluation of HIV drug resistance and other infections. For transplant recipients with HIV, additional considerations might include:

• Using health care providers with different specializations
• Maintaining HIV viral suppression
• Preventing post-transplant infections
• Monitoring kidney and liver function
• Monitoring drug effectiveness
• Considering pill burden (how many pills a person has to take)
• Maintaining, modifying, or changing HIV medicines to minimize drug interactions

These considerations help to ensure that people with HIV have better access to safe and effective transplants. With these considerations, transplants can often be safe and effective for people with HIV.

This fact sheet is based on information from the following sources: 

From the Organ Procurement and Transportation Network:

• HOPE Act

From the HIV Clinical Practice Guidelines at Clinicalinfo.HIV.gov:

• Guidelines for the Use of Antiretrovirals in Adults and Adolescents With HIV:
  • Transplantation in People With HIV

From National Institute of Allergy and Infectious Disease:

• Allergy, Immunology & Transplantation

From CDC:

• Clinical Guidance for Transplant Safety

From Medline Plus:

• Transplant Services

Also see the HIV Source collection of HIV links and resources.

Where can people with HIV find a health care provider?

Health care providers are an essential part of successful HIV treatment. They prescribe HIV medicines and order tests to monitor their patients' health. People with HIV work with their health care providers to select an HIV treatment regimen that works best for their needs.

The following resources can help you find a health care provider—

• State HIV/AIDS Hotlines, from HRSA
  If you need help finding a health care provider or HIV/AIDS-related services in your area, call your state's HIV/AIDS hotline. The Health Resources and Services Administration (HRSA) maintains a list of HIV/AIDS hotlines for the United States, the U.S. Virgin Islands, and Puerto Rico.
• Find a Ryan White HIV/AIDS Program Medical Provider, from HRSA
  The Ryan White HIV/AIDS Program provides HIV treatment services to people with HIV who have no health insurance or who are underinsured. Use the Find a Ryan White HIV/AIDS Program Medical Provider search tool linked above to find medical providers in your area participating in the Ryan White HIV/AIDS Program.
• Find HIV Services Near You, from HIV.gov
  This search tool from HIV.gov can help you locate services, programs, and centers for HIV testing, sexually transmitted infection (STI) testing, pre-exposure prophylaxis, mental health, family planning, housing assistance, substance abuse, and the Ryan White HIV/AIDS program.

Where can people with HIV get help paying for HIV medicines?

There are several resources that can help people with HIV get the medicines they need:

• ADAP Directory, from the ADAP Advocacy Association
  Use this directory to find AIDS Drug Assistance Programs (ADAPs) in the United States and several U.S. territories that provide HIV medicines and other services to those without sufficient health insurance or who need financial assistance.
• NASTAD Membership Directory
  Use the National Alliance of State and Territorial AIDS Directors' (NASTAD) directory to find health care specialists who administer HIV health care programs in your state.
• Drug Companies
  Some companies that make HIV medicines also have drug assistance programs. To find the contact information for the manufacturer of an HIV medicine, search for the drug in the Clinicalinfo Drug Database and then scroll down the drug fact sheet to the section titled "Manufacturer Information."

How can people with HIV get help with mental health issues?

Anyone can have problems with mental health, but people with HIV are more likely to experience some mental health conditions (such as depression) than people without HIV. Read the HIVinfo HIV and Mental Health fact sheet for more information.

Below are some places to find mental health treatment services—

• Find Help, from SAMHSA
  Substance Abuse and Mental Health Services Administration (SAMHSA) is a U.S. government agency that offers resources for those looking for help with mental health problems or substance abuse. SAMHSA's treatment locator allows people to search for mental health and substance use treatment facilities in the United States. SAMHSA also operates a 24-hour National Suicide Prevention Lifeline.

Help for Mental Illnesses, from NIMH
As part of the National Institutes of Health (NIH), the National Institute of Mental Health (NIMH) funds research on ways to prevent and treat mental health disorders. Their website includes a resources page to help people find health care providers and treatment services, locate clinical trials, and learn more about mental health.

Where else can people with HIV find resources for treatment?

Many assistance programs and resources are available through state health departments, providing support for treatment and other valuable resources. These programs may include—

• Medication assistance: Helping people afford HIV medicines for treatment.
• Support programs: Connecting people to counseling, housing assistance, and peer support networks.
• Healthcare navigation: Helping people access care and insurance options, including Medicaid and Ryan White HIV/AIDS program services.

To find out which services are available in your state, visit your state health department for more information.

How can HIVinfo help?

If you have questions about HIV treatment or need help finding HIV treatment resources, HIVinfo health information specialists (available in English or Spanish) can assist you. Contact HIVinfo by phone (1-800-448-0440) or email ([email protected]) for confidential assistance. For more information, visit the HIVinfo Contact Us page.

Also see the HIV Source collection of HIV links and resources.

How can people with HIV prepare for travel?

Prepare enough HIV medicine to cover the whole stay, plus potential delays.

It is important to continue taking your HIV medicine as prescribed, even when traveling. Bring enough HIV medicine to cover the length of your travel, plus a few days extra in case of delays. In some cases, you may need to work with your health care provider to get HIV medicines in another location.

When traveling by plane or internationally, all prescription medicine should be in its original packaging, labeled with dosage, your name, and your date of birth. Keep your HIV medicine in your carry-on luggage so that if your checked luggage gets lost, you can take your HIV medicine on time.

If you are traveling internationally, be aware that access to your HIV medicine may differ in other countries. Your medicine may not be available or could be very expensive. Additionally, medicine that is legal in the United States may be illegal or require a special permit in other countries.

Check the U.S. Department of State’s Travel Information for your destination or contact the U.S. Embassy or Consulate in your destination country to confirm if your medicine is legal or restricted.

Research your destination.

If you are traveling outside of the United States, be aware of HIV-related travel restrictions. The type of restriction varies by country.

Some countries prohibit people with HIV from entering and may deport visitors based on their HIV status. Although you are not required to disclose your HIV status in these countries, bringing HIV medicine may indicate your HIV status and result in deportation.

Other countries do not ban people with HIV from entering and staying less than 90 days but require either HIV testing or HIV status disclosure for work, study, or residency permits.

To learn more about travel restrictions based on HIV status—

• Check the Centers for Disease Control and Prevention’s Travelers With HIV webpage.
• Contact the U.S. Embassy or Consulate in your destination country for more information.

Additionally, be aware of local laws and cultural attitudes toward same-sex relations and marriage. According to the U.S. Department of State, more than 60 countries consider consensual same-sex relations a crime. For other considerations related to sexual orientation, see the U.S. Department of State’s recommendations for lesbian, gay, and bisexual travelers.

Discuss your travel plans with your health care provider.

A few months before your trip, talk with your health care provider about your travel plans, including your destination, the length of your trip, and your planned activities. Depending on your destination, your health care provider may recommend vaccines or medicines to prevent diseases like cholera or malaria. 

Be sure to remind your health care provider of your current HIV medicine and any other medicines you are taking so that they can check for potential drug-drug interactions if additional vaccines or medicines are necessary.

Your health care provider can also help ensure that you continue taking your HIV medicine while traveling. If you are traveling across time zones, you may need to adjust the time at which you take your HIV medicine.

Ask your health care provider or pharmacist how to time your dosing when traveling, especially if you are taking long flights. In some cases, your health care provider can also work with you so that you can get your HIV medicine in another location.

If you are concerned about bringing HIV medicine with you, talk with your health care provider about temporarily switching to long-acting HIV medicines. Long-acting HIV medicines can be administered as an injection every one or two months. They are not suitable for trips longer than two months unless your health care provider can help arrange additional injections as needed while you are away.

If you are traveling abroad, you might need to bring documentation for any medication you are taking. Ask your health care provider for a letter that lists your medications (including their generic names and dosing) as well as your information.

Explore health insurance or supplemental travel insurance options.

Health care abroad is usually not covered by standard health insurance, including Medicare and Medicaid. Check with your health insurance provider to determine if medical care abroad is covered. You may want to consider purchasing supplemental travel insurance that will cover care for pre-existing conditions like HIV or medical evacuations in the event of an emergency.

For more information on travel insurance, visit the U.S. Department of State’s website.

How can people with HIV stay safe while traveling?

Continue taking your HIV medicine as prescribed.

Changes in time zone, jet lag, long flights, and busy schedules can keep you from taking your medicine on time. Missing doses of your HIV medicine can lead to HIV drug resistance, treatment failure, and transmission to others. It can also make you more vulnerable to other illnesses, like opportunistic infections.

Therefore, it is important to continue taking your HIV medicine as prescribed. If you miss a normal dose, take the medicine you missed as soon as possible, unless it is almost time for your next dose. For more tips on sticking to your HIV treatment, see the HIVinfo fact sheet Following an HIV Treatment Regimen: Steps to Take Before and After Starting HIV Medicines.

Take steps to prevent other illnesses.

Foodborne and waterborne illnesses are likely to be more serious and last longer in people with HIV than in people with a healthy immune system. You can reduce your risk of foodborne illness by being careful about what you eat and drink.

• Water: Avoid drinking tap water, drinks that are made of unheated tap water, and drinks that have ice in areas where the tap water might be contaminated. In most cases, factory-sealed bottled water is safer than tap water.
• Raw food: Avoid eating raw or undercooked meat and seafood. Be careful of consuming raw fruits and vegetables (and foods that contain raw fruits and vegetables) that you did not prepare yourself.
• Milk: Avoid consuming milk and other dairy products like cheese or yogurt that are unpasteurized.
• Bushmeat: Avoid handling or eating bushmeat (meat harvested from wild animals, such as bats, rodents, and monkeys). Bushmeat can carry germs that cause serious illnesses, like Ebola.

Bugs such as mosquitoes and ticks can spread vector-borne diseases, like malaria, dengue, and yellow fever. These diseases are likely to be more serious in people with weakened immune systems. If you are traveling to an area with vector-borne diseases, take steps to avoid bug bites by—

• Wearing loose, long-sleeved shirts and long pants
• Using Environmental Protection Agency-registered insect repellent
• Sleeping under a mosquito net

If you are traveling within the United States, visit the CDC’s webpages on Where Ticks Live and Where Mosquitoes Live to learn where and when these diseases are more common. If you are traveling abroad, visit the CDC’s Destinations webpage to learn more about what illnesses are common in your destination country.

What should people with HIV do if their HIV medicine is lost or damaged?

If your HIV medicine is lost or damaged while traveling within the United States, visit a pharmacy near you with a copy of your prescription.

If you are traveling internationally to a low- or middle-income country, you may encounter counterfeit or fake medicine. Despite looking like real medicine, counterfeit medicine can contain ineffective amounts of medicine and/or wrong or harmful ingredients.

The best way to avoid counterfeit medicines is to bring your own medicine. However, if your HIV medicine is misplaced or compromised, take the following steps to avoid counterfeits:

• Buy medicine from a reputable source, like a licensed pharmacist.
• Inspect the packaging for suspicious details. Misspellings or poor-quality printing can be a sign of a counterfeit.

If you are traveling abroad, the U.S. Embassy or Consulate in your destination country can assist you in finding English-speaking health care providers and clinics.

This fact sheet is based on information from the following sources:

From the HIV Clinical Practice Guidelines at Clinicalinfo.HIV.gov:

• Guidelines for the Prevention and Treatment of Opportunistic Infections in Adults and Adolescents With HIV
  • Immunizations for Preventable Diseases in Adults and Adolescents With HIV

From the Centers for Disease Control and Prevention:

• Counterfeit Medicines
• Travelers With HIV
• Traveling Abroad With Medicine
• Avoid Bug Bites
• Risk and People Who Are Immunocompromised | Vector-Borne Diseases

From the U.S. Department of State:

• Your Health Abroad
• Travel Insurance
• Lesbian, Gay, and Bisexual Travelers

From the U.S. Food and Drug Administration:

• Traveling With Prescription Medications