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Can Cannabis Help HIV/AIDS?
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Gleb Oleinik by Gleb Oleinik

Overview

Cannabis is becoming a popular alternative treatment for the management of HIV/AIDS symptoms. It has been shown to help with a wide range of debilitating symptoms associated with both the disease and with antiretroviral therapy, including weight loss, nausea, pain, anxiety, and depression.

Thanks to these benefits, the medical use of cannabis in HIV/AIDS is increasingly recognized by clinicians. Recent studies indicate that cannabis may even address HIV directly by reducing viral load, helping slow the progression of the disease. Cannabis appears to be a relatively safe treatment, with mostly minor and transient side effects. Data therefore suggests that it may work as an effective adjuvant to standard retroviral therapy. 

The Endocannabinoid System

Consisting of cannabinoid receptors, endocannabinoids, and the enzymes that build and break them down, the endocannabinoid system (ECS) helps maintain homeostasis: a healthy state of balance in the body. This system regulates many key physiological processes, including immune, cognitive, and gastrointestinal function, along with mood, sleep, pain, and metabolism.

The ECS contains two main endocannabinoids: anandamide and 2-AG. These compounds are synthesized when needed and broken down shortly afterward. They produce their effects by acting on two known cannabinoid receptors, CB1 and CB2. Although these receptors are found throughout the body, CB1 is particularly abundant in the central nervous system, and CB2 is widespread in immune cells.

The body’s cannabinoid receptors and enzymes can also interact with plant-derived cannabinoids such as CBD and THC, which is how cannabis can produce its beneficial health effects.

At this time, there isn’t any research looking directly at the involvement of the ECS in HIV/AIDS. Having said that, we do know that the ECS regulates processes involved in the symptoms of HIV/AIDS and antiretroviral therapy, such as pain, appetite, and cognitive and gastrointestinal function. Furthermore, the immunomodulatory effects of the ECS may even help slow the progression of HIV/AIDS.

Regulating pain

For starters, the endocannabinoid system plays a key role in pain regulation. In fact, the ECS is present and involved in every part of the pain pathway. For example, CB1 receptors are widespread in parts of the central and peripheral nervous systems implicated in sensing, carrying, and processing pain signals. For example, a study in rats where CB1 receptor activation resulted in relief of neuropathic pain. Meanwhile, CB2 receptors are abundant in immune system cells, highlighting their particular involvement in inflammatory pain, and have also been discovered in sensory neurons related to neuropathic pain. Furthermore, 2-AG and anandamide have pain-relieving properties, highlighting their role in pain reduction.  Indeed, chronic pain is the most common reason doctors prescribe cannabis to patients in general. In sum, this evidence suggests that we can target the ECS to relieve the chronic pain that afflicts HIV/AIDS sufferers and neuropathy-related pain in particular.

Stimulating appetite, suppressing nausea

Additionally, researchers know that the endocannabinoid system plays a role in regulating appetite and food intake. Most notably, CB1 receptor activation is known to stimulate appetite, an effect utilized by THC-based drugs such as dronabinol to counteract HIV-related weight loss. Similarly, activation of CB1 receptors in the dorsal vagal complex of the medulla oblongata, a part of the brain that controls involuntary reflexes such as sneezing, is known to suppress vomiting, another common issue for HIV/AIDS sufferers. This can make a dramatic difference in the quality of life of those with HIV who suffer from nausea and a lack of appetite as a result of HIV antiviral therapies.  

Furthermore, the endocannabinoid system regulates gut function. For example, the activation of CB1 receptors seems to reduce gastrointestinal motility, the movement of muscles in the gut whose dysfunction is associated with a host of digestive symptoms, including nausea, bloating, diarrhea, and abdominal pain. As such, targeting the ECS may help with these and other digestive issues seen in people with HIV/AIDS.

The endocannabinoid system has also been implicated in mental health and may play a role in disorders such as anxiety and depression. In fact, brain imaging studies in patients with mental disorders have reported alterations in all three components of the ECS: cannabinoid receptors, endocannabinoids, and related enzymes. This means targeting the ECS may also help with anxiety, depression, and other mental health issues that often develop in people with HIV/AIDS.

Halting virus progression

Lastly, the endocannabinoid system’s regulation of immune function may even play a role in halting the progression of HIV/AIDS. Indeed, the ECS is known to have a wide range of immunomodulatory effects, such as impacting the growth and survival of immune cells, the production of proinflammatory cytokines, immune cell activation, and inflammatory cell migration. These effects may help counteract the chronic, systemic inflammation that plays a central role in HIV’s persistence and explain why some studies have found that cannabis-based compounds reduce HIV viral load.

In sum, research suggests that the endocannabinoid system regulates bodily functions affected by HIV/AIDS, which means targeting it can offer relief for this difficult-to-treat condition.

Treatment

Given the involvement of the ECS in virtually every process affected by HIV/AIDS, it’s not surprising that numerous studies have reported that cannabis-based medicines relieve the weight loss, nausea, chronic pain, anxiety, depression, and other debilitating symptoms associated with the condition and the antiretroviral therapies used to treat it.

To begin with, a landmark 1995 study demonstrated that THC-based drug dronabinol can treat AIDS wasting syndrome, which brings about weight loss. In this study, 139 AIDS patients saw improvements in appetite and maintained or even gained body weight (in 22% of the sample). The treatment also improved mood and decreased nausea. 

Similar findings were reported by a 2005 trial, where both dronabinol and whole cannabis increased food intake among patients suffering from AIDS-related weight loss. These effects are so consistent that cannabis is now routinely used to counteract AIDS-related wasting.  Few to no other therapies can alleviate symptoms of wasting as effectively and safely as cannabis.

Furthermore, cannabis can help manage the chronic pain associated with HIV, such as neuropathic pain. For example, a 2008 clinical trial looked at the effects of smoked cannabis in 28 people with HIV-related neuropathic pain. Patients smoking cannabis experienced significant pain relief, with 46% having a 30% or greater reduction of pain. This percentage is 2.5 times higher than the 18% of patients who received a placebo and achieved the same reduction of pain. 

Similar findings were reported by a 2007 study in which a total of 50 patients with HIV-related neuropathic pain smoked placebo or regular cannabis, with 52% of the cannabis patients having a 30% or greater improvement in daily pain. This was about twice the percentage of those in the placebo group (24%) who had the same reduction in pain.

Cannabis-based medicines can also help reduce nausea and vomiting, two other common symptoms associated with HIV/AIDS and antiretroviral therapy. For example, a 2007 study compared the effects of THC-based dronabinol with the drug ondansetron in the treatment of chemotherapy-induced nausea. Both drugs had similar efficacy in improving nausea. However, the dronabinol group had the lowest nausea and vomiting intensity, with 71% of patients experiencing a complete absence of nausea. 

Moreover, cannabis treatment may also help with anxiety and depression, two common mental health issues in HIV/AIDS patients. For instance, a 2011 study reported that the non-psychoactive cannabinoid CBD reduced anxiety induced by public speaking in individuals with social anxiety disorder (SAD).

Meanwhile, a 2013 Dutch study found that administering THC to 11 healthy individuals reduced negative biases in emotional processing, leading the researchers to suggest that the endocannabinoid system “may thus be relevant for psychiatric disorders such as major depression.” The previously mentioned study of dronabinol for the treatment of AIDS-related wasting also noted an improvement in mood. In addition, many anecdotal reports by HIV/AIDS patients note improved mood with cannabis use.

While more research looking at the benefits of cannabis in HIV/AIDS is sorely needed, current evidence suggests that cannabis is effective in relieving many symptoms experienced by HIV/AIDS sufferers.

As effectively summarized by experts from the National Academies of Science, “Both anecdotal evidence and scientific research suggests that cannabinoids could soothe a variety of symptoms suffered by AIDS patients: nausea, appetite loss, pain, and anxiety. Although more effective medicines than marijuana already exist to treat these conditions, they are not equally effective for all patients, nor do they offer the broad spectrum of relief that might be obtained from cannabinoid drugs.”

Cannabis & HIV/AIDS Progression

In addition to relieving HIV/AIDS symptoms, some research indicates that cannabis might even reduce the progression of HIV through the immunomodulatory effects of the ECS.

Most notably, a 2015 study reported that recently infected people with HIV who were heavy cannabis users had a lower HIV viral load. Similar findings were reported by a 2016 study, where HIV-positive cannabis users had a lower viral load than nonusers.

Meanwhile, 2011 animal study in rhesus macaque monkeys looked at the effects of THC on the HIV-like simian immunodeficiency virus (SIV). The monkeys were given THC for 28 days before and several months after the infection. The treatment reduced the progression of SIV, highlighted by reduced early mortality, retention of body mass, and lower viral load. Furthermore, a 2014 cell culture study found that THC protected immune cells from HIV-1 virus infection.

New and existing antiviral HIV medications have made tremendous strides in stopping the progression of HIV by making the viral load undetectable in those taking them every day.  That also helps prevent the spread of HIV. Unfortunately, they do have side effects. By mitigating those side effects and alleviating associated symptoms related to taking these medications, cannabis indirectly plays a role in limiting disease progression and helping prevent the spread of HIV to new individuals by increasing compliance.  

Side Effects

Although cannabis seems to offer much relief to HIV/AIDS sufferers, its side effects continue to be a barrier to its medical use. Most notably, cannabis may cause psychoactive side effects such as impaired memory, euphoria, anxiety, and paranoia. Furthermore, it can cause minor non-psychoactive effects such as sleepiness, tiredness, dry mouth, and red eyes. 

On the whole, however, these effects are relatively minor and passing, especially when weighed against potential benefits. It is important to note that there have been no recorded overdoses in cannabis leading to death, which provides further evidence of its safety.

Some research suggests that using medical cannabis in smoked form may increase the risk of certain complications in HIV/AIDS patients. For example, a 2019 study reported that long-term smoking of cannabis was associated with increased risk of lung disease in HIV-infected individuals. However, these potential downsides can be avoided by using cannabis in many of the non-smoking formulations available today.

 

Legal Use

Because the use of cannabis-based medicines for certain complications of HIV/AIDS — such as weight loss and nausea — is widely recognized by clinicians, it’s possible for sufferers to access cannabis in most countries with medical programs. 

For starters, many countries, such as Canada, Israel, Macedonia, Greece, Finland, Argentina, Belgium, Costa Rica, Croatia, the Philippines, Czech Republic, and the Netherlands, consider HIV/AIDS or a specific issue caused by it a qualifying condition. Additionally, some countries, including Italy, Australia, Ecuador, Switzerland, and Denmark, consider symptoms such as chronic pain and nausea qualifying conditions, which means medical cannabis can still be prescribed to HIV/AIDS patients. 

Furthermore, it may be possible to get medical cannabis in countries that don’t list specific conditions and leave it up to individual physicians to decide whether the treatment is necessary, such as Germany, Norway, Paraguay, Poland, Uruguay, and Estonia.

Meanwhile, in the United States, medical cannabis can be prescribed for HIV/AIDS in Puerto Rico, Guam, the District of Columbia, and 32 states: Alaska, Arizona, Arkansas, California, Colorado, Connecticut, Delaware, Florida, Hawaii, Illinois, Louisiana, Maine, Maryland, Massachusetts, Michigan, Missouri, Montana, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Dakota, Ohio, Oregon, Oklahoma, Pennsylvania, Rhode Island, Washington, West Virginia, Utah, and Vermont.

About HIV/AIDS

Overview

HIV stands for Human Immunodeficiency Virus. It’s a type of virus that attacks the cells that help you fight off infections, increasing your risk of catching another infection or illness. 

HIV has a number of stages, or phases. Each one has different symptoms, and the final stage is called AIDS, which stands for Acquired Immuno-Deficiency Syndrome. Without treatment, it may take about 10 years for HIV to progress to AIDS, though this varies widely from person to person. With today’s advanced medications, called antiretrovirals, you can prevent AIDS from developing for several decades. In fact, most people with HIV avoid ever developing AIDS and can lead long healthy lives.  

Despite these medications, and education campaigns that have done a lot to reduce the spread of HIV, there are still around 36.9 million people living with HIV worldwide, most of them in sub-saharan Africa. In 2017, approximately 940,000 people died from AIDS-related illnesses. 

In the US, there are 1.1 million people with HIV, and over 38,000 Americans were newly diagnosed with the virus in 2017.

Symptoms

HIV has different symptoms, depending on which stage of the illness you’re at.

Stage 1 HIV: Acute HIV

Acute HIV refers to the first 2-8 weeks after you’ve become infected. During this time there’s a very high amount of the virus in your bloodstream, which can make you feel flu-like symptoms that are your body’s natural response to infection. But not everyone who catches HIV feels sick; there can be a delay of up to several weeks before you feel any symptoms; and the symptoms might be so mild that you don’t even notice them. 

Symptoms of acute HIV include:

  • A rash 
  • Headache and joint pain
  • A fever
  • Swollen lymph glands
  • A sore throat, as well as painful sores in the mouth
  • Diarrhea or other GI symptoms 

Stage 2: Latency

The latent period is also called a time of clinical latency, HIV inactivity, dormancy, or chronic HIV. At this point, HIV is largely asymptomatic and you have very low levels of the virus in your blood. Some people have ongoing swollen lymph nodes during this time, but otherwise you wouldn’t know that you have HIV. However, it’s still present in the body. 

Without treatment, this stage lasts for years. During the latent period, you can still infect others with HIV, making it important to take precautions. If you take the medication prescribed to you, you can achieve an undetectable viral load, meaning that the amount of HIV in your bloodstream is so small that it’s undetectable. As long as you have an undetectable viral load, you can’t pass it on to others. 

Towards the end of this stage, your viral load starts to rise. The number of T cells, which are the cells that attack infection in your body, starts to drop. That can cause you to show more symptoms, including:

  • Frequent coughs and colds
  • Fever
  • Ongoing tiredness
  • Weight loss
  • Shingles (herpes zoster) or oral yeast infection (thrush)
  • Diarrhea
  • Pain
  • Memory changes

These symptoms show that your infection is moving in to stage 3 – AIDS. 

Stage 3: AIDS

AIDS is the final and most serious stage of HIV. Most people with AIDS survive about 3 years. Symptoms of AIDS include:

  • Weakness and weight loss
  • Fever or chills
  • Swollen lymph glands
  • Rashes or bumps on your skin
  • Night sweats
  • Chronic diarrhea
  • Persistent and unexplained white spots on your tongue or in your mouth
  • Symptoms of dementia 
  • Pain and neuropathy 
  • Multiple infections involving the skin, respiratory system, and GI system.

When you have AIDS, it means that your immune system is severely damaged, so it can’t manage to fight off even minor infections. Illnesses that would be insignificant in a healthy person can be very dangerous to someone with AIDS. These are often called opportunistic illnesses. People with AIDS are also very susceptible to opportunistic cancers that don’t usually affect people with a healthy immune system.

When to see a doctor

If you think that you might have been exposed to HIV, you should see your doctor right away. Early and consistent treatment with the right medications is key to preventing HIV from developing into AIDS. It is also important in preventing the spread of HIV to others. We now know that early treatment of HIV can prevent the advance of the disease and can lead to long healthy lives in carriers.  

If you think that you have any of the symptoms of AIDS, you should also seek treatment as soon as possible.

Diagnosis

The only way to definitively prove HIV is through a blood or saliva test. Your doctor can test for antibodies to HIV, which takes up to 12 weeks to develop. They also test for the HIV antigen, which is the protein that the virus produces inside your bloodstream. This can be tested within weeks of potential contact with the infection.  

You can also buy home testing kits for HIV, but you should still go to discuss the results with a doctor. 

If you are found to be HIV positive, your doctor will probably do a few more tests to check the stage of your HIV. HIV tests include:

  • Viral load test (HIV RNA), to check for the level of the virus in your bloodstream. The lower the result, the better.
  • CD4 cell count measures the number of white blood cells (T cells) that are destroyed by HIV.
  • Drug resistance tests determine whether you’ve been infected with a strain of HIV that is resistant to medication, making it harder to treat.

When your CD4, or T cell count, drops below 200 cells/mm, you’ll be diagnosed with AIDS, even if you’re not yet showing symptoms.

Causes

HIV is a virus that’s transmitted through bodily fluids. That means that you can’t catch it if someone sneezes on you or touches you, or by shaking hands or hugging someone. It’s a sexually transmitted infection (STI), but it can also be spread through contact with infected blood, such as through a blood transfusion, or be passed from a mother to her baby during pregnancy, birth, or breastfeeding.

It’s thought that HIV began as a disease in chimpanzees in Africa, and later spread to humans when people hunted infected chimpanzees and ate their meat. HIV may have jumped to humans as early as the late 19th century. It slowly spread across Africa, and then to the rest of the world. It arrived in the US sometime in the 1970s.

Treatment

There’s no cure or vaccine for HIV, but there are medications that stop it from progressing and developing into AIDS. These medications are called antiretrovirals, and taking them is called antiretroviral therapy, or ART. Antiretrovirals can help people at every stage of HIV, even if you don’t manage to begin taking them at an early point. 

When you take antiretrovirals from an early stage of HIV, you can avoid becoming infectious. People who are treated with antiretrovirals from the beginning of their infection can live as long as someone without HIV. 

There are a few different types, or classes, of anti-HIV medications. It’s best to combine drugs from a few different classes. 

  • Non-nucleoside reverse transcriptase inhibitors (NNRTIs) such as efavirenz (Sustiva), etravirine (Intelence), and nevirapine (Viramune).
  • Nucleoside or nucleotide reverse transcriptase inhibitors (NRTIs) like Abacavir (Ziagen), and emtricitabine/tenofovir (Truvada), Descovy (tenofovir alafenamide/emtricitabine), and lamivudine-zidovudine (Combivir), which are combination drugs. 
  • Integrase inhibitors like raltegravir (Isentress) and dolutegravir (Tivicay).
  • Entry or fusion inhibitors like enfuvirtide (Fuzeon) and maraviroc (Selzentry).
  • Protease inhibitors (PIs) like atazanavir (Reyataz), darunavir (Prezista), fosamprenavir (Lexiva) and indinavir (Crixivan).

Although ART is very effective against HIV, it causes issues of its own. Many anti-HIV drugs need to be taken at specific times, every single day for the rest of your life. They can also have side effects that include: 

  • High blood sugar levels
  • Heart disease
  • A breakdown of your muscle tissue (rhabdomyolysis)
  • Loss of bone strength
  • Vomiting, diarrhea, and nausea

Some common medications for heart disease, or metabolic conditions, also don’t interact well with anti-HIV drugs. People with HIV can also find it more difficult to cope with the natural effects of aging.

Alternative therapies

Many people with HIV turn to alternative therapies and herbal supplements in order to help manage the side effects of antiretroviral drugs and keep them stronger for longer. It’s important to know that some supplements, like St. John’s Wort and garlic supplements, can interfere with anti-HIV drugs and make them less effective. You should always check with your doctor before starting to take a supplement, to make sure that it won’t affect your medications. 

It’s also critical to take steps to live a healthy life so that your body is as strong as possible. Healthy lifestyle advice for people with HIV includes:

  • Avoiding raw meat, eggs, fish, and unpasteurized dairy products. These raw foods can be infected with bacteria that could cause serious illness in people with HIV. 
  • Eating healthy foods, like plenty of whole grains, fresh fruit and vegetables, and lean protein. These foods give you the energy you need to remain healthy and keep your immune system strong.
  • Getting all your immunizations and keeping them up to date, so that you reduce your risk of catching infections like pneumonia and the flu, which can also be more serious in people with HIV. But avoid vaccinations that use a live virus. 
  • Being careful with animals, because some pets and companion animals can carry parasites that cause infections in people with HIV. For example, reptiles can carry salmonella, birds can carry cryptococcus or histoplasmosis, and cat feces can carry toxoplasmosis. For this reason, you need to wash your hands well after handling pets or emptying litter boxes.

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