AIDS/HIV

Medical Cannabis and AIDS/HIV

The most common treatment for AIDS and HIV is antiretroviral therapy (ART), which has proven to be quite effective. Medical cannabis is not necessarily used for treating AIDS or HIV but to manage the side effects of the condition and its treatment, such as chronic pain, nausea, and appetite loss.

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What is AIDS/HIV?

HIV stands for human immunodeficiency virus (HIV) that, as the immune system is progressively destroyed, can develop into acquired immune deficiency syndrome (AIDS). There are two species of Lentivirus (a subgroup of retrovirus) that causes HIV infection. HIV infects helper T cells (specifically CD4+ T cells, which can create HIV “reservoirs” that render the infection incurable at the moment), macrophages, and dendritic cells.

Approximately 1.2 million people were living with HIV in the U.S. in 2013. HIV is most often spread via unprotected sex. Still, contaminated blood transfusions, needle sharing, and transmission from mother to child during pregnancy, delivery, or breastfeeding are other ways of being infected by HIV. “AIDS” is usually applied in late-stage HIV when it has developed into its final form.

Brief Summary of Current Treatments

AIDS and HIV are treated with antiretroviral drugs. There are 24 FDA-approved drugs available for the treatment of HIV-1 infections. These drugs are separated into six classes:

1. Nucleoside-analog reverse transcriptase inhibitors (NRTIs), aka nucleoside analogs
2. Non–nucleoside reverse transcriptase inhibitors (NNRTIs)
3. Integrase inhibitors
4. Protease inhibitors (PIs)
5. Fusion inhibitors
6. Coreceptor antagonists

Examples of antiretroviral drugs include abacavir, emtricitabine, tenofovir, efavirenz, etravirine, and nevirapine.

How Might Medical Cannabis Help?

While the treatments we have for HIV/AIDS have proven to be quite effective, not everyone can tolerate them, and even if a person can, the side effects of these medications can prove to be debilitating. Cachexia (wasting syndrome, or sudden weight loss), nausea, peripheral neuropathy, and joint and muscle pain are side effects of the disease and some medications. The medical use of cannabis could help with all of these symptoms. Terpenes and terpenoids are also being researched for their potential anti-HIV activity.

Cannabinoids

THC and CBD. CBD may be beneficial as an anti-inflammatory, while THC can help manage pain and nausea and increase appetite.

CBDV and CBG could be helpful as well for their anti-inflammatory properties.

Cannabinoid Ratios

THC:CBD 1:1

THC-rich products and cannabis chemotype.

Terpenes and Terpenoids

• Beta-caryophyllene
• Myrcene
• Pinene

Flavonoids

• Cannflavins A, B and C
• Quercetin
• Rutin
• Luteolin
• Kaempferol

Effective Ways of Taking Medical Cannabis for AIDS/HIV

Routes of Administration

• Oral
• Sublingual
• Topical
• Transdermal

Special Formulations

A cannabis strain (cultivar), extract, or product rich in THC and beta-caryophyllene could be ideal. Some CBD products can help reduce inflammation and lift mood.

Dosing Methods

• Inhalation (vaporizer, inhaler)
• Tincture (sublingual)
• Edible
• Drinkable
• Transdermal patch
• Topicals and salves

What are the Pros and Cons of Taking Medical Cannabis for AIDS/HIV?

Potential Pros

• CBD may inhibit the growth of certain types of herpes virus, which can help if a person living with AIDS has multiple infections.
• Cannabis may control inflammation in those with AIDS/HIV and may even slow the progression of HIV to some extent.
• Cannabis can help stimulate the appetite, especially as cachexia and loss of appetite are common side effects of AIDS/HIV and the medications used to treat it.
• Beat nausea and vomiting.
• Improve the mood and reduce fatigue and insomnia, depending on the cannabinoids needed and desired.
• People living with HIV/AIDS may suffer from muscle pain and neuropathic pain.
• Medical cannabis may suppress HIV viral replication.

Potential Cons

• Cannabis that isn’t well-grown may contain pathogens that cause an infection.
• “Dry” or “cotton” mouth – a common side-effect of AIDS/HIV treatment — may be exacerbated by cannabis use.
• Cannabinoids may further dampen the immune system.
• Cannabis smoke may irritate the throat and lungs, and recovering from such injuries takes longer with AIDS/HIV.
• Some studies show that cannabis may increase the viral load, and a national cohort study shows no relationship between cannabis use and HIV viral load.

Useful Anecdotal Information

“HIV / AIDS Information: AIDS and Medical Marijuana Treatments,” United Patients Group

“Can Marijuana Help AIDS Patients? | Marijuana”

Scientific Data Overview and Studies

• Total Studies = 48
• Positive Studies = 32
• Inconclusive Studies = 14
• Negative Studies = 2
• 30 Meta-Analyses (17 positive, 21 inconclusive, two negative); 6 Animal Studies (all positive); 5 Double-Blind Human Trials (3 positive, two inconclusive); 7 Lab Studies (6 positive, one inconclusive)
• 6 studies includes CBD (4 positive, 2 inconclusive); 21 studies include THC (18 positive, 3 inconclusive); 1 study includes CBG (positive)
• No. of Leafwell Patients (2021) = 228
• Possible Overall Efficacy: Moderate

Quotes from Studies

“Heavy cannabis users had decreased frequencies of human leukocyte antigen (HLA)-DR+CD38+CD4+ and CD8+ T-cell frequencies, compared to frequencies of these cells in non-cannabis-using individuals. Heavy cannabis users had decreased frequencies of intermediate and nonclassical monocyte subsets and reduced frequencies of interleukin 23- and tumor necrosis factor-α-producing antigen-presenting cells.

While the clinical implications are unclear, our findings suggest that cannabis use is associated with a potentially beneficial reduction in systemic inflammation and immune activation in antiretroviral-treated HIV infection.” Source: Manuzak JA, Gott TM, Kirkwood JS, Coronado E, Hensley-McBain T, Miller C, Cheu RK, Collier AC, Funderburg NT, Martin JN, Wu MC, Isoherranen N, Hunt PW, Klatt NR.’ Heavy Cannabis Use Associated With Reduction in Activated and Inflammatory Immune Cell Frequencies in Antiretroviral Therapy-Treated Human Immunodeficiency Virus-Infected Individuals.‘ Clin Infect Dis. 2018 Jun 1;66(12):1872-1882. doi: 10.1093/cid/cix1116. PMID: 29471387; PMCID: PMC6248381.

“Because HIV attacks the immune system, it wreaks havoc throughout the body. Besides providing a foothold for opportunistic infection and cancer, the virus also triggers a potentially lethal wasting syndrome, painful nerve damage, and dementia. Finally, in addition to the physical discomforts inflicted by HIV, many people with AIDS also struggle with depression and anxiety. Marijuana, some patients say, eases all of these problems and more.” Mack, A, Joy, J, Marijuana as Medicine? The Science Beyond the Controversy. Washington (DC): National Academies Press (US); 2000.

Conclusion

Medical cannabis may help manage chronic pain, neuropathic pain, nausea, appetite loss, and weight loss associated with HIV and AIDS and their treatment. Evidence suggests that medical cannabis could hamper efforts to reduce HIV/AIDS viral load due to cannabinoids’ immunomodulatory effects. Still, the results are not consistent across all studies. Some of the negatives of medical cannabis for managing the side effects of AIDS and antiretroviral treatment could be mitigated by avoiding consumption by smoking.

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