Cannabis in HIV and AIDS

Dr Sona A Pungavkar *

Cannabis has been used as an adjunct, over the counter, treatment for HIV-related complications as well as the side effects of the antiretroviral drugs since early days of the epidemic. Cannabis helps to reduce pain, nausea and weight loss associated with HIV infection.

The human body is protected from pathogens by the white blood cells. A special type of white blood cells, called as CD4 T or T-helper cells are killed by the Human immunodeficiency virus (HIV), following infection.

When a bacterium or a virus infects the body, CD4 T cells produce two types of responses. The first reaction is to inform the other white blood cells about the site of infection. Second, they cause multiplication of other white blood cells, which in turn create antibodies. These attach to the invading pathogen as well as the infected cells, so that the immune system can locate and destroy them.

Because of the loss of the helper cells, the body is open to attack by agents which can cause life threatening infections, as the body is unable to put up a fight, eg diarrhoea, meningitis etc, due to a deteriorating immune system. The condition is labelled as acquired immunodeficiency syndrome (AIDS).

Pharmaceutical medications used for to treat HIV and AIDS are called antiretroviral drugs and are available in various preparations. These are called as HAART viz .highly active antiretroviral therapy.

Although these drugs bring about a benefit in terms of reduction of the viral load in the body, these have side effects such as severe pain, loss of appetite and weight, fatigue and wasting. Patients often discontinue treatment, because of the added component of anxiety and depression.

It is already known that medicinal Cannabis, when smoked or ingested as an oil or tincture, alleviates pain, nausea and vomiting.

A publication in the journal of Acquired Immunodeficiency Syndrome showed that, patients using Cannabis, in addition to conventional treatment, experienced relief from depression, anxiety, pain and had improvement of appetite in addition to an overall increase in pleasure.

Adding Cannabis to the HAART regimen, allowed patients to continue using the antiretroviral medications for a longer period, compared to those who used HAART alone. This is a result of a 252- patient review published in 2005 in the same journal.

There are studies which show that Cannabis does not interfere with the retroviral therapy and their effects, which clears the way for adding Cannabis to the regimen.

Besides symptomatic relief for the various side effects accompanying HAART therapy, Cannabis also directly acts on the cells of the immune system infected by HIV. In 2003, a randomized-controlled study from the University of San Francisco was published in Annals of Internal medicine and included 62 HIV- positive patients.

These were divided into 3 groups. One group received a placebo. Another group got to smoke a joint to obtain natural Cannabis, while the remaining 20 received a synthetic preparation resembling Cannabis. The results stated that there was 20% increase in the CD4 cell count in Cannabis using HIV patients.

Also noted was 20% increase in CD8 cell counts in users of natural Cannabis / THC and 10 % increase in a synthetic preparation of THC, which is interesting and may be the result of the entourage effect expected in the natural plants.

Another study in mice in 2011, showed that there was a decrease in the viral load, slowing of the disease progression and decrease in overall inflammation.

In 2016, in a study of 55 HIV- positive patients, the participants were divided into three categories, i.e, non-users, light users, and moderate to heavy users. A reduced viral load, and an increased CD4 T cell count, was observed in both light and moderate/heavy cannabis users, compared to patients who didn’t take cannabis.

University of Florida has a US$ 3.2 million grant from the National Institute on Drug Abuse to conduct a study for 5 years. It started in 2017 and will involve 400 HIV positive patients. This is the biggest Cannabis / HIV study and is headed by Dr Robert Cook. The results will be available in 2022.

Another study protocol published in 2019 in British Medical Journal included precise quantities of oral cannabinoids in 26 patients. It is a randomized trial pattern examining the association between oral cannabinoids and their effect on inflammation and the viral load in HIV patients. They noted dose variations were a requirement in the patients and dose titration was needed on individual basis. This study will form a base for future larger studies.

HIV infected patients now live longer than previously, because of the improved treatment options. Hence, maintaining the quality of life is a very important issue.

This subset of people is already known to be smoking Cannabis as part of normal routine and are already aware of the benefits.

Medicinal Cannabis greatly diminishes the side effects of HAART therapy, and it also influences the cells of the endocannabinoid system to directly fight the virus. Hence, it can be considered as an option for adjunctive treatment and the treating physicians could have an open discussion regarding this with the patients, taking HAART.