Comments from Keith Henry, MD
The following information is abstracted from "The Norvir Switch" by Mark Schoofs.
Director, HIV Clinic, Regents Hospital. St. Paul, Minnesota
and Don Des Jarlais, PhD, Beth Israel Medical Center, New York City
Most doctors feel that objections to the syrup's alcohol content will be rare, partly because the capsules contain some alcohol, too, though less than the liquid. "I'm not worried about this," says Keith Henry, MD, director of the HIV clinic at Regents Hospital in St. Paul, Minnesota, who has a high percentage of patients with substance-abuse problems. Like many physicians, Henry notes that patients would only be taking a teaspoon at a time, too small an amount to trigger cravings in most recovering alcoholics. Don Des Jarlais, PhD a veteran substance abuse researcher at New York City's Beth Israel Medical Center, who is developing the the alcohol issues section of the IAPAC Norvir Advisory, agrees that "the quantity is so low that you would expect no noticeable physiological response." But he's quick to caution that "the psychology could be extremely complicated. Somebody who believes he has to be completely clean and sober might say, 'I can have this alcohol [in the ritonavir], so maybe I can go up to a drink a day.'" How common will that problem be? "I honestly don't know," he says.
Henry, however, has another reason for believing Norvir won't make most recovering alcoholics fall off the wagon: "Ritonavir has a built-in Antabuse
effect," he says. "It makes you feel lousy, and it tastes bad. So it would be the unusual alcoholic who would be looking forward to this." Laughing, Des Jarlais says, "That's actually a good point. Taking this stuff is not self-reinforcing. You don't take it and decide it feels so good you'll take more."