From the earliest days of the HIV epidemic, marijuana (cannabis) has been used to treat many of the complications of disease, ranging from the symptoms of HIV wasting syndrome to side effects associated with antiretroviral drug use.
While newer generation drugs have greatly reduced the incidence and severity of many of these conditions, marijuana is still popularly embraced as a means to alleviate the pain, nausea, weight loss, and depression that can accompany infection. There have even been suggestions that marijuana may afford long-term benefits by effectively slowing—or even preventing—progression of the disease. So what are the facts?
What is HIV?
HIV, or human immunodeficiency virus, is a disease that compromises a person’s immune system by killing protective white blood cells. As this defensive system shuts down, other harmful infections, called “opportunistic infections,” thrive. Meningitis, pneumonia, encephalitis, tuberculosis, chronic diarrhea, and cancers are some examples of these infections. The advancement of HIV leads to AIDS, or acquired immunodeficiency syndrome, defined by the appearance of additional infections and a low CD4+ T cell count.
The primary treatment for HIV/AIDS is high active antiretroviral therapy (HAART), a mixture of medications that slow the disease’s progression. Pharmaceuticals may also be prescribed to manage opportunistic infections, AIDS-related symptoms, and the side effects of other prescription drugs.
Daniel J. Kane, an AIDS patient, described the tiring and frustrating task of juggling various drugs. “Wasting syndrome, in combination with other HIV-related symptoms and conditions, left me thoroughly disabled and desperate to obtain relief,” he said. “I suffered severe nausea, chronic exhaustion and physical weakness, neurological complications, persistent anxiety, and a total loss of appetite…I became too ill to ingest the pills that lay at the core of my treatment. Despite my attempts, I simply could not swallow them with any regularity. When I did swallow them, I rarely kept them down.”
About one third of HIV/AIDS patients experience severe pain as a result of the antiretroviral therapy, and other common responses to AIDS medication include nausea, vomiting, appetite loss, and weight loss. The adverse side effects can be so debilitating that patients will abandon their treatment, and long-term vitality, for relief. Patients supplementing their regimen with cannabis, however, are 3.3 times more likely to continue their HAART treatment. The reason for this significant increase is multifaceted.
Research Supporting Marijuana in Treating HIV
While the support for marijuana in the treatment of HIV is strong, much of the supporting research is still limited. This is due, in large part, to the fact that laws regulating marijuana use have constrained rigorous scientific investigation.
Marijuana has been used by people living with HIV since the early days of the epidemic. Today, a growing number of people with HIV may be using marijuana, and the drug itself has changed dramatically from a plant that’s usually smoked to a diverse menu of plant-based and synthetic products.
But today’s cannabis products are fundamentally different from the marijuana older people may have smoked in their youth. In 1995, the potency of the average marijuana plant was around 4%. By 2014, growers were cultivating plants with 12% potency out of the ground. And, with the decriminalization and legalization of marijuana in many states, people are increasingly using highly potent products like vapor, edibles, and wax.
In fact, a synthetic product called “shatter” contains 80% THC. Meanwhile, a few pharmaceutical cannabinoid products have been approved, including cannabidiol, dronabinol, nabilone, and nabiximols.
From the early-1980s to the mid-1990s, HIV was a major contributor to death and illness in the United States. Early generation HIV drugs were prone not only to premature failure, they often came with serious and sometimes debilitating side effects.
Moreover, people living with the disease were at high risk of illnesses we don’t see as frequently these days, including Kaposi’s sarcoma (a rare form of skin cancer), AIDS dementia, and the aforementioned HIV wasting syndrome.
It was, in fact, this last condition which first spurred support for the use of medical marijuana. Doctors, who at the time had few options for treatment, surmised that marijuana’s appetite-stimulating properties could benefit those experiencing the profound, unexplained weight loss as a result of this still-mysterious condition.
Since laws at the time largely forbade the use of marijuana in clinical settings, doctors began to prescribe the Schedule III drug Marinol (dronabinol), which contains a synthetic form of tetrahydrocannabinol (THC), the active ingredient of cannabis.
While Marinol proved to be successful in alleviating many of the symptoms of HIV wasting, many still preferred the “instant hit” afforded from three to four puffs of a marijuana cigarette.
The results of one 252-patient review showed that combining the use of cannabis with HAART made patients withstand antiretroviral medications for significantly longer periods of time, compared to patients who weren’t using cannabis.
Another survey published in the Journal of Acquired Immune Deficiency Syndrome showed that HIV patients who used cannabis in combination with their regular treatment experienced significant relief from anxiety, depression, pain, and had improved appetite. They also reported an overall increase in pleasure.
Besides offering palliative aid for numerous side effects that accompany HAART therapy, several studies have found that cannabis also directly influences how the human body reacts to this virus.
Even though scientific data is still somewhat scarce, several studies confirmed that cannabis directly acts on the cells of the immune system affected by HIV.
According to a 2016 study published in the AIDS Care (a peer-reviewed medical journal publishing research related to HIV/AIDS), there is a complex relationship between cannabis use and HIV status.
55 HIV-positive patients, some of which are also regular cannabis users, participated in the study. They were divided into three categories: non-users, light users, and moderate to heavy users.
The study found that both light and moderate/heavy cannabis users had a lower viral load, and a higher number of CD4 T immune cells, compared to patients who didn’t consume cannabis.
Another 2003 study from UCSF included 62 HIV patients who were randomly separated into three groups.
20 patients received a placebo, 20 patients got cannabis in the form of a joint, and 22 received dronabinol (FDA-approved medication containing synthetically created and isolated THC, branded and sold as Marinol or Syndros).
The study went on for 25 days, and after comparing results, the researchers found that there was a 20% increase of CD4 T cells in both real-cannabis and dronabinol groups.
The team behind this study also found that the number of CD8 T-cells rose 20% in the real-cannabis group, and 10% in patients who were given dronabinol.
CD8 T cells of the immune system could be considered as the secondary target for the HIV virus, right after CD4 T cells.
Biggest cannabis/HIV study is yet to come
University of Florida received a 3.2 million dollar grant from the National Institute on Drug Abuse in 2017 to conduct a 5-year study on the effects of cannabis on HIV.
It will be the biggest and the most comprehensive research on this topic to date, and it will include 400 HIV patients from Florida.
Head researcher Robert Cook (MD, MPH), shared his views on the goals of the study:
I’ve seen some very interesting data that looked at just how much of the virus is in people’s blood before they were treated with antiretrovirals.
The research showed that those who used marijuana had a lower amount of the virus in their blood compared to those who didn’t use marijuana.
That’s a good thing if there is a lower amount of the virus.
But I haven’t seen any clinical trials looking at the direct effects of THC on the virus.
We also don’t have a lot research comparing THC alone versus THC and CBD on people with HIV.
This study will surely provide the much-needed insight for HIV-infected patients.
Patients considering medical marijuana for HIV/AIDS symptom management should always consult a physician before using cannabis, but knowing what options are available can make a world of difference.