By Amanda Hayes, PCA
Cannabinoid Therapy in HIV
Cannabinoid Therapy in HIV
The number of individuals with HIV who use cannabis is “2-3 times higher than in the general population.” People with HIV (PWH) are using cannabinoids to manage their symptoms of nausea, sleeping disorders, musculoskeletal and neuropathic pain, anxiety, and depression. [1] Dronabinol is FDA approved as an appetite stimulant to help treat weight loss and anorexia in HIV/AIDS patients. Studies including dronabinol have shown increased caloric intake and weight gain. Marinol and Syndros is approved for therapeutic uses including anorexia and is associated with weight gain in AIDS patients.[2]
Persistent inflammation occurs when someone has HIV. Persistent inflammation includes coinfections-especially cytomegalovirus (CMV) and gut dysbiosis. When CMV flares up in a PWH, the body reacts with an inflammatory response. With gut dysbiosis, chronic inflammation occurs with the loss of healthy gut flora, along with the release of microbial products from the gut into the bloodstream. Hepatitis C is another coinfection commonly occurring in Patients with HIV that may release or translocate microbials into systemic circulation, which is another potential source of inflammation for HIV patients. Persistent Inflammation can also negatively affect the central nervous system through the production of neurotoxic cytokines, resulting in cognitive impairment and depression.
Adverse effects of persistent inflammation include myocardial infarction, neurocognitive impairment, and even death. Cannabinoids are believed to have an anti-inflammatory effect on the endocannabinoid system, making it potentially beneficial for PWH (people with HIV).[3]
The Endocannabinoid System (ECS) is composed of a roadmap of receptors throughout the human body. The ECS regulates critical body functions such as temperature control, pain control, inflammatory responses, immune responses, sleep cycles, mood regulation, memory, and learning.[4] When cannabinoids like THC and CBD enter the human body, they are “mediated” by the ECS, producing anti-inflammatory effects. This is specifically relevant to HIV, which is “characterized,” by persistent inflammation. PWH who are heavy cannabis users showed “reduced frequencies of antigen-presenting cells that produced pro-inflammatory interleukin-23 and tumor necrosis factor.”
In addition to helping increase appetite, cannabis-based medicine may help treat many of the symptoms of pain associated with AIDS, including the burning sensation of neuropathic pain, neuroinflammation, neurocognitive impairment. [5]
The variety of cannabinoids and terpenes present in cannabis each have “unique pharmacological actions,” that work synergistically to create an “entourage effect,” depending on the potency, blend, and spectrum of the formulation. When the formulation contains a broad or full spectrum of terpenes and cannabinoids, PWH may experience more relief from their symptoms, suggesting that isolate formulations of cannabinoids such as isolate tinctures, edibles, and elixirs containing only THC and/or CBD may have limited effects, as with dronabinol, which is a synthetic form of tetrahydrocannabinol.
Potential physiologic side effects of cannabinoids may include hypotension with reflex tachycardia, gastroparesis, ataxia, somnolence, and dry mouth. Psychologic side effects may include euphoria, poor concentration, anxiety, delusions, and hallucinations at high doses. These side effects may be dependent on the dose taken and the age of the prescribed patient. A tolerance for cannabis develops over approximately two weeks, which may lessen these symptoms.[6]
Annotated Bibliography
Ellis, R. J., Wilson, N., & Peterson, S. (2021). Cannabis and inflammation in HIV: A review of human and animal studies. Viruses, 13(8), 1521. https://doi.org/10.3390/v13081521
This 2021 review focuses on persistent inflammation that occurs in people with HIV (PWH) and how exogenous cannabinoids interact with the Endocannabinoid System (ECS) to reduce persistent inflammation. This study also shares specific information on statistics of PWH who use cannabis to manage their symptoms. Specifically, PWH use cannabis 2-3 times more than the general population; heavy cannabis users showed reduced frequencies of antigen-presenting cells that produced pro-inflammatory interleukin-we and tumor necrosis factor-a; HIV-infected cannabis users had lower inducible IP-10 levels in plasma. Both preclinical and clinical evidence support the anti-inflammatory effects of exogenous cannabinoids.
FDA regulation of cannabis and cannabis-derived products, including cannabidiol (CBD). (n.d.). U.S. Food and Drug Administration; FDA. Retrieved July 7, 2022, from https://www.fda.gov/news-events/public-health-focus/fda-regulation-cannabis-and-cannabis-derived-products-including-cannabidiol-cbd
The FDA recognizes the interest to develop therapies using cannabis and its components, more specifically cannabinol (CBD). The FDA promises to maintain and protect the interest of public health which taking steps to improve the efficiency of regulatory pathways for lawful marketing of cannabis-derived products. Despite listing “Marihuana” as a substance to be controlled by the Controlled Substances Act (CSA) due to its high potential for abuse, the psychoactive effects of THC, and the absence of a currently accepted medical use of the plant in the United States, the FDA has approved Marinol and Syndros (contains synthetic delta-9 tetrahydrocannabinol) for therapeutic use in the treatment of anorexia and weight loss in AIDS patients.
Grinspoon, P. (2021, August 11). The endocannabinoid system: Essential and mysterious. Harvard Health. https://www.health.harvard.edu/blog/the-endocannabinoid-system-essential-and-mysterious-202108112569
Harvard Health article explaining the function of the recently-discovered endocannabinoid system (ECS), which regulates the critical body functions of temperature control, pain control, inflammatory responses, immune responses, and sleep control. This network of signals and receptors are throughout the body are stimulated by endocannabinoids, which have a very similar structure to cannabinoids in the cannabis plant. The first endocannabinoid discovered was anandamide, Sanskrit for “bliss.”
James, J. S. (1999). Medical marijuana: AIDS-related information in the new Federal report. AIDS Treatment News, 319, 6–8. https://www.ncbi.nlm.nih.gov/books/NBK224400/
This 1999 book on “Marijuana and Aids” reveals small-scale polls show that 60% of California buyer’s clubs are patients seeking relief from HIV/AIDS symptoms. Cannabis purportedly soothes a variety of symptoms of HIV/AIDS. Patients report using cannabis to calm their stomach after taking their medication, stimulate their appetite, ease their pain and regulate their mood. More physical discomforts listed include wasting syndrome, susceptibility to infection, nerve damage, and dementia. Psychological trauma could include depression and anxiety. Some report relief from these symptoms using cannabis.
Cannabinoids in the treatment of symptoms in cancer and AIDS. (2019, January 29). Palliative Care Network of Wisconsin. https://www.mypcnow.org/fast-fact/cannabinoids-in-the-treatment-of-symptoms-in-cancer-and-aids/
This article explains the use of cannabinoids to treat symptoms related to cancer and AIDS. There is a brief explanation of the pharmacology of cannabinoids, and the FDA drugs that are approved for therapeutic treatment of nausea and vomiting in chemotherapy patients who do not respond to conventional antiemetics. This article also discusses the use of Dronabinol for anorexia associated with weight loss in HIV/AIDS patients. Side effects of hypotension with reflux, tachycardia, gastroparesis, ataxia, somnolence, and dry mouth are also symptoms.
[1] Ellis, R. J., Wilson, N., & Peterson, S. (2021). Cannabis and inflammation in HIV: A review of human and animal studies. Viruses, 13(8), 1521. https://doi.org/10.3390/v13081521
[2] FDA regulation of cannabis and cannabis-derived products, including cannabidiol (CBD). (n.d.). U.S. Food and Drug Administration; FDA. Retrieved July 7, 2022, from https://www.fda.gov/news-events/public-health-focus/fda-regulation-cannabis-and-cannabis-derived-products-including-cannabidiol-cbd
[3] Ellis, R. J., Wilson, N., & Peterson, S. (2021). Cannabis and inflammation in HIV: A review of human and animal studies. Viruses, 13(8), 1521. https://doi.org/10.3390/v13081521
[4] Grinspoon, P. (2021, August 11). The endocannabinoid system: Essential and mysterious. Harvard Health. https://www.health.harvard.edu/blog/the-endocannabinoid-system-essential-and-mysterious-202108112569
[5] James, J. S. (1999). Medical marijuana: AIDS-related information in the new Federal report. AIDS Treatment News, 319, 6–8. https://www.ncbi.nlm.nih.gov/books/NBK224400/
[6] Cannabinoids in the treatment of symptoms in cancer and AIDS. (2019, January 29). Palliative Care Network of Wisconsin. https://www.mypcnow.org/fast-fact/cannabinoids-in-the-treatment-of-symptoms-in-cancer-and-aids/