January 9, 2019
In many ways, the progress of modern cannabinoid medicine has its roots in HIV/AIDS medicine, with efforts as early as the 1990s by industry leaders like the late Denis Peron paving the way towards access to cannabis for HIV/AIDS patients.
Acquired immunodeficiency syndrome (AIDS) is a chronic, incurable, potentially life-threatening condition caused by the human immunodeficiency virus (HIV). HIV, a sexually transmitted infection (STI), also spread between mother and child through childbirth or breastfeeding, interferes with and causes damage to the immune system and the body’s ability to fight disease.
According to amfAR, the Foundation for AIDS Research, an estimated 1.1 million people in the United States are living with HIV, and about 15% of those don’t know they are infected. In 2016, 18,160 people were diagnosed with AIDS and there were 6,465 AIDS-related deaths in 2015.
Common Symptoms & Medical Cannabis Interventions
HIV and AIDS patients turn to medical cannabis for a number of symptoms that are common within the diseases but also show up in other medical conditions treated with medical cannabis.
One of the common medical cannabis dosing methods is through the FDA-approved Dronabinol (“Marinol”), which is an oral dose of THC (Delta-9 tetrahydrocannabinol). Other individuals may turn to alternate methods of ingestion like smoking or vaporizing to receive the benefits of cannabis.
While clinical research is limited due to the federally illegal status of cannabis in the U.S., some of the following studies offer insights into the efficacy of medical cannabis for common HIV/AIDS symptoms, including:
Loss of Body Weight
Delta-9 tetrahydrocannabinol (THC) in the synthetic form of Dronabinol (“Marinol”) was registered as an anti-emetic in 1985 and in 1992 as an aid for AIDS patients experiencing excessive loss of body weight. Other methods of ingestion of cannabis, such as smoking or vaporizing, also help with addressing issues surrounding loss of body weight. A 2005 UK study from Imperial College and Chelsea and Westminster Hospital examined the efficacy of medical cannabis for 143 HIV patients, 64 of which complained of weight loss. 45% indicated that cannabis made this complaint “much better”, 24% reporting “little better”, and 31% reporting no change. There were no reports of “little worse” or “much worse” in terms of cannabinoid therapy for weight loss (Woolridge et al, 2005).
Change in Appetite & Low Caloric Food Intake
THC has been widely accepted as an appetite stimulant, with researchers believing there is a tie between THC and the hormones that stimulate hunger. A 2011 University of California study of 7 HIV-infected men measured insulin levels and plasma levels of ghrelin, leptin, and PYY in HIV-infected subjects before and after receiving smoked cannabis or placebo in a clinical trial. On average, both ghrelin and leptin levels increased with cannabis treatment and slightly decreased or remained unchanged with placebo (Riggs, P.K., et al, 2011).
Nausea and Vomiting
Nabilone, a synthetic cannabinoid was the first cannabis medicine registered, in 1981, for the suppression of nausea and vomiting due to cancer chemotherapy. A 2007 study in the Journal of Acquired Immune Deficiency Syndromes looked at cannabis intake of 10 HIV-positive participants. It observed that Dronabinol and cannabis increased daily food intake by increasing the number of times participants ate throughout the day (Haney et al, 2007)
A 2009 single group, double-blind, placebo-controlled, crossover trial published in Neuropsychopharmacology assessed the impact of smoked cannabis on neuropathic pain in 28 subjects with HIV. Cannabis was associated with a sizeable (46%) and significantly greater (vs 18% for placebo) proportion of patients who achieved what is generally considered “clinically meaningful” pain relief (Ellis, 2009).
Slowing the Progression of the Virus & Immune Suppression
In 2012, Mount Sinai School of Medicine researchers discovered that cannabis-like chemicals trigger receptors on human immune cells that can directly inhibit a type of human immunodeficiency virus (HIV) found in late-stage AIDS. The researchers found that by treating the cells with a cannabinoid agonist that triggers the CB2 receptors, the CB2 blocked the signaling process, and suppressed infection in resting immune cells. Research is also developing to look at how cannabis can influence the increase of CD4 counts.
Inflammation of the Lymph Nodes
Inflammation and swelling of the lymph glands are a common complaint of those with HIV or AIDS. While specific HIV/AIDS studies regarding inflammation are lacking, a 2009 review of U.S. published in The Journal of Opioid Medicine of controlled clinical studies with medical cannabis conducted over a 38-year period found that “nearly all of the 33 published controlled clinical trials conducted in the United States have shown significant and measurable benefits in subjects receiving the treatment.” The review notes “that the more than 100 different cannabinoids in cannabis have the capacity for analgesia through neuromodulation in ascending and descending pain pathways, neuroprotection, and anti-inflammatory mechanisms” (Aggarwal et al, 2009).
People in the late stages of HIV or AIDS complain of pain and stress that cause sleep disturbance and insomnia. A 2015 review completed at the University of McGill Health Centre Montreal and published in The Journal of Sleep Disorders and Sleep pointed out that clinical research is focused on the symptom management issues that affect sleep. Dronabinol (“Marinol”) is commonly used to reduce agitation and pain affecting sleep. The review raised the issue of the lack of evidence for cannabinoid medicine on sleep architecture, but pointed to the emerging research on cannabinoids and pain, agitation, stress, anxiety, and other disorders affecting sleep as a positive indicator of cannabis’ effect on sleep (Ferguson and Ware, 2015).
A review in Current Drug Abuse Reviews hypothesized the connection between cannabis use and memory loss with those with HIV, citing “there is some evidence that individuals infected with HIV recruit additional brain regions during memory tasks to compensate for HIV-related declines in neurocognitive functioning”, calling for more research on the topic (Sklaski et al, 2016).
Mood Disorders, Anxiety, and Depression
The 2007 study referenced above in the Journal of Acquired Immune Deficiency Syndromes assessed the effects of oral Dronabinol (“Marinol”) and smoked cannabis observing a wide range of behaviors in HIV-positive cannabis smokers. The study concluded that oral dronabinol and smoked cannabis “improve mood without producing disruptions in psychomotor functioning” (Haney et al, 2007).
Cannabis or “Marinol”?
Many physicians will opt to prescribe Dronabinol (“Marinol”) because it is an FDA-approved medication, yet the evidence is suggesting that smoked and ingested cannabis is just as effective, if not more effective, at reducing common HIV/AIDS complaints, making it an attractive option for those in legal cannabis states.
Adverse Side Effects
Americans for Safe Access report that amongst HIV/AIDS patients, “no adverse health effects related to medical cannabis use have been reported, even among the most seriously ill and immunocompromised patients.”
Aggarwal, Sunil K., et al. “Medicinal use of cannabis in the United States: historical perspectives, current trends, and future directions.” Journal of opioid management 5.3 (2009): 153-168.
Ellis, Ronald J., et al. “Smoked medicinal cannabis for neuropathic pain in HIV: a randomized, crossover clinical trial.” Neuropsychopharmacology 34.3 (2009): 672.
Ferguson, G, and Ware, MA. “Review Article: Sleep, Pain and Cannabis”. Journal of Sleep Disorders & Therapy (2015). https://www.omicsonline.org/open-access/review-article-sleep-pain-and-cannabis-2167-0277.1000191.php?aid=40536#33
Haney, Margaret, et al. “Dronabinol and marijuana in HIV-positive marijuana smokers: caloric intake, mood, and sleep.” JAIDS Journal of Acquired Immune Deficiency Syndromes 45.5 (2007): 545-554.
“Marijuana-Like Chemicals Inhibit Human Immunodeficiency Virus (HIV) in Late-State AIDS” https://www.newswise.com/articles/chemicals-in-marijuana-inhibit-human-immunodeficiency-virus-hiv-in-late-state-aids
Riggs, P.K., et al., A pilot study of the effects of cannabis on appetite hormones in HIV-infected adult men, Brain Res. (2011), doi10.1016/j.brainres.2011.11.001
Skalski, Linda M, et al. “The impact of marijuana use on memory in HIV-infected patients: a comprehensive review of the HIV and marijuana literature.” Current drug abuse reviews 9.2 (2016): 126-141
Woolridge, Emily, et al. “Cannabis use in HIV for pain and other medical symptoms.” Journal of pain and symptom management 29.4 (2005): 358-367.
About the Author
Philip M. Cohen is CEO of CMN Holdings, Inc. and their subsidiaries, Cannabis Medical Network, a digital media network airing in cannabis doctors waiting rooms and Cannabis Lifestyle Network, airing in dispensary waiting rooms. Phil has operated a dozen ad-supported digital signage networks in doctor offices and at retail since 1985 and is a past Chairman of the Digital Signage Federation.