On World AIDS Day, we examine the science behind taking medical cannabis to help manage some of the symptoms.
Wednesday 1 December marks World AIDS Day, dedicated to raising awareness of HIV/ AIDS and also mourning those who passed away.
The UN AIDS estimates that 37.7 million people globally were living with HIV in 2020. They also estimate that since the start of the epidemic, 36.3 million people have died from AIDS-related illnesses.
What is HIV?
The first cases of HIV/AIDS were recorded in the late 70s and early 80s. As the first cases began to originate in the gay community, the disease was originally referred to as ‘GRIDS’ which stood for Gay-Related Immunodeficiency Disease.
Human Immunodeficiency Disease (HIV) is a virus that affects the immune system. It damages and weakens the cells making it easy for opportunistic diseases or infections to get in. The body is unable to defend itself. HIV is found in the semen, vaginal and anal fluids, blood and breast milk of those with the virus. It can be passed from person to person but AIDS cannot. Most people with HIV, thanks to advances in science may go on to develop AIDS but live with the disease for longer periods of time.
How do HIV and AIDS differ?
Acquired Immunodeficiency Deficiency Syndrome (AIDS) is the name given to a collective group of opportunistic illnesses that occur after the immune system has been damaged by HIV.
The most common ways to transfer HIV is through unprotected anal or vaginal sex or sharing unclean needles. The NHS estimate that 80 per cent of those who contract HIV will experience a flu-like illness for one to two weeks after infection. The most common symptoms are sore throat, raised temperature, rashes, tiredness, joint pain or swollen glands.
Could Medical Cannabis help with HIV symptoms?
HIV and Appetite loss
One of the first reasons why patients began to turn to medical cannabis in the 80s to help with symptoms was to counteract AIDS wasting syndrome and associated pain.
The lack of appetite means patients may seldom feel hungry enough to eat or feel well enough to prepare a meal. Cannabis helped patients experiencing this to regain their appetite. It is estimated that the prevalence of wasting syndrome can be between 14 and 38 per cent.
In the late 80s, doctors started to prescribe Marinol which contains synthetic tetrahydrocannabinol.
Joint Pain
Peripheral neuropathy, or nerve pain, happens when some of the nerves get damaged. It can cause stabbing pains, burning, or tingling sensations in the hands and feet. HIV and antiretroviral medications may trigger the pain. HIV When the immune system is weakened this makes it easier to get other infections that can cause peripheral neuropathy.
Marinol was often prescribed for neuropathic pain as well as appetite stimulation. Cannabis was thought to help with some of the nerve pain caused by early AIDS medication such as AZT. Neuropathic pain, which is where the exterior sheath covering nerve cells is stripped away exposing nerve endings resulting in chronic pain.
A review from 2018 suggested that medical cannabis may be a tolerable and effective neuropathic agent. The researchers analysed over 16 different studies with 1750 participants.
The authors wrote: “The evidence appears to support the safety and efficacy of short-term, low-dose cannabis vaporization and oral mucosal delivery for the treatment of neuropathic pain. The results suggest medical cannabis may be as tolerable and effective as current neuropathic agents; however, more studies are needed to determine the long-term effects of medical cannabis use.”
Better sleep
THC may help with improving the quality of sleep experienced by HIV+ patients. One of the symptoms of HIV can be night sweats which make it difficult to stay asleep or cause poor quality rest. This results in increased fatigue which can leave a patient feeling more run down and stressed as a result.
Night sweats occur when the body is attempting to fight a disease such as HIV. This often accompanies joint pain, unexplained weight loss, fever and chills.
A study suggested that consuming cannabis with higher THC levels can reduce the amount of REM sleep patients experience. This means a deeper, more restful sleep which can lead to better, restorative rest.
Leaning into terpenes can also help. Some terpenes are thought to be really helpful for better sleep including Linalool which is found in lavender, geraniums and jasmine.
Better cognitive function
A study from New York in the journal, AIDS Care, reported that HIV+ patients who consumed cannabis showed the same or greater cognitive performance than non-users.
Researchers took 138 HIV+ patients of which 47 had a history of cannabis use while 91 did not. Those with a history of cannabis use were found to have ‘better processing speed, visual learning, memory and dominant hand motor ability.’
Reduced neuroinflammation due to HIV
A study from San Diego examined if daily cannabis use might reduce central nervous system inflammation in a cohort of patients with and without HIV.
The researchers noted that those who consumed cannabis had lower levels of chronic inflammation compared to those who did not. Furthermore, the users’ results were similar to the HIV subjects with no history of cannabis use.
This may make it useful for preventing or delaying the development of HIV Associated Dementia which is where the virus spreads to the brain. It can cause memory loss, difficulty thinking, concentrating and speaking clearly. It is a progressive disease that sadly gets worse with time.
It may also help with HIV Associated Neurocognitive Disorder which is often found in the later stages of the disease. It causes progressive loss of memory, behaviour and motor function problems.
Different forms of dementia and some cognitive issues are thought to be caused by inflammation. It has been linked to a number of different conditions such as Alzheimer’s Disease, depression and anxiety. Although more research is needed to understand how cannabinoids interact with our endocannabinoid system and the receptors in our bodies, a study from 2016 shows THC may be neuroprotective.
Authors wrote: “Cannabinoids such as tetrahydrocannabinol stimulate the removal of intraneuronal Aβ, block the inflammatory response, and are protective.”
Mental Health
As with any long term health condition, there can often be a lot of anxiety and depression around diagnosis.
Some cannabinoids such as THC and CBD are thought to potentially help with anxiety. It may induce feelings of calm, improve relaxation and also help with better quality sleep.
There is some debate over the balance of THC and CBD when it comes to anxiety. Some believe that lower doses of THC while higher CBD hybrids may help reduce the risk of worsening symptoms. Alternatively, some patients choose to balance their own ratios depending on their particular symptoms on the day by combining CBD and THC in different ways.
HIV and T-cell count
When HIV enters genetic information into our T cells, it makes copies of itself causing the helper T cells to die. This disrupts our immune response allowing opportunistic infections to get in without detection or fight.
CD4 are referred to as ‘helper cells’ that help the body to recognise pathogens with a protein called CD4. However, CD8 T cells are referred to as ‘killer cells’
Killer T cells seek out pathogens and help to destroy them preventing infection. If T Cells fall below a certain number, a person may go on to receive an AIDS diagnosis. Certain medications, such as chemotherapy, can affect a T cell amount so it is important to note if a new prescription may be safe to take or not with HIV.
One study from 2008 offered a longitudinal analysis of both HIV+ and HIV- men who reported that their cannabis did not have an impact on the CD4 and CD8 T cell counts.
How to get a medical cannabis prescription for HIV/AIDS
This requires self-referring or asking your GP to refer you to a clinic in the UK for assessment. The clinics will not be able to diagnose HIV or AIDS but will be able to discuss the options with you.
Medical cannabis is usually assumed to be the last option if prescription medication has not worked to control the symptoms. After an initial assessment, your doctor at the clinic can discuss if cannabis is the best possible option, what you can expect to experience and how the costs work.
A prescription may be offered in a number of different formulas such as oils, flowers or topicals.
What is the best way to take medical cannabis for HIV/AIDS?
There is no right or wrong way to take medical cannabis or CBD for HIV/AIDS. The best way is to talk to your doctor about what will suit your current condition and lifestyle. If a patient is experiencing problems with a sore throat which is common with the flu symptoms or fungal infection such as oral thrush, then swallowing edibles may be difficult. Alternatively, vaping may aggravate lung pain.
Edibles or vaping may be a better option if the taste of oils creates a problem. Keeping a journal of your medical cannabis intake can be helpful when it comes time to have your first follow up appointment or in assessing how a particular product is working for you.
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