Can cannabis help HIV/AIDS?

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.  

Potential side effects of cannabis use

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.