Approximately 25% of all people living with HIV choose to utilize cannabis to manage symptoms ranging from nausea and appetite loss to distal neuropathy, fatigue, insomnia, depression and anxiety. Many of these symptoms are associated with HIV itself, while others stem from the life-saving Antiretroviral Agents that allow people to live with HIV. People living with HIV who use cannabis to manage symptoms report effectiveness similar to that of prescription or OTC medications, across a range of symptoms; however, the ability to act on many symptoms at the same time distinguishes cannabis from other symptom management agents.

Deciding whether cannabis is the right agent to treat your HIV-related symptoms probably brings up a host of questions you will want to look at with your doctor. At FARMACEUTICALRXwe believe all healthcare choices should be made with the best possible information available.  We hope the following research will help you and other community members living with HIV evaluate the potential pluses and minuses of medical cannabis use.

Which HIV-related symptoms is cannabis used to treat?

  • Appetite and Weight Loss:  Cannabinoids are most often cited to treat appetite and weight loss in HIV, most likely because of the early testing and marketing of dronabinol (synthetic THC) for this purpose.  Cannabinoids are effective in this area, although not as effective as megestrol acetate. However, unlike megestrol acetate, which may exacerbate insomnia, several studies of cannabis for appetite loss in people with HIV demonstrate ancillary positive effects of cannabinoids on sleep and mood.
    • It is important to note that cannabis use has a tendency to increase caloric intake in the form of fats and carbohydrates rather than protein, and associated weight gain thus tends toward fat rather than lean muscle mass.  Nutritional counseling can help avoid unwanted outcomes by providing strategies for increasing healthy protein intake, and a physical therapist or trainer can be enlisted to help you maintain or rebuild lean muscle through an exercise regimen that includes progressive resistance.
  • Nausea: Patients with nausea, and especially those with severe nausea, preferentially use and highly rate the effectiveness of cannabis. Patients in one large survey reported marijuana to be better than prescribed or OTC medications for HIV-related nausea.  One study found that use of medical cannabis improved antiretroviral therapy adherence rates among patients with nausea.
  • GI Disturbances: Several studies suggest that cannabis is effective in ameliorating general GI symptoms which are prevalent among people living with HIV and which otherwise require OTC medications;  in one study, participants requested OTC medication for GI issues 19 times during the placebo phase of the study as opposed to one time during active cannabinoid administration (56% of all OTC medication requests versus 9% of all OTC medication requests).
  • HIV-related Sensory Neuropathy: Treatment choices are few for those suffering from HIV related sensory neuropathy, the most common neurological complication of HIV infection; such neuropathy, which often results from treatment toxicity, affects 40% of people living with HIV and causes disabling pain which may persist despite conventional analgesia.   Evidence suggests that cannabis is a good treatment choice if you have HIV-related sensory neuropathy (HIV-SN), especially as an alternative to long-acting narcotics that are prescribed when pain is severe and refractory to analgesics and anticonvulsants.   Two randomized, placebo controlled trials of medicinal cannabis, one as sole therapy and one as adjuvant therapy to conventional painkillers, both demonstrated efficacy for HIV-SN.  Patients in one large survey reported marijuana to be better than prescribed or OTC medications for HIV-related neuropathy.
  • Anxiety, Depression and Insomnia  As noted above, various studies have found ancillary positive effects of cannabis on mood and sleep in patients with HIV.   In one survey of 775 participants living with HIV, marijuana users reported lower anxiety than non-users; users who had used both marijuana and other medications for symptom management rated marijuana as more effective than anti-anxiety medicines for anxiety, but rated anti-depressants as more effective than marijuana for both depression and anxiety.

Will cannabis negatively affect my viral loads or immune status?

Despite concerns that cannabis use might compromise immunity and increase viral loads, both human and animal model studies have demonstrated that chronic cannabis use either (1) is not associated in either direction with HIV viral loads or levels of circulating CD4 and CD8 T cells, or in some studies, (2) is associated with lower viral loads.    Chronic cannabis use thus appears to be safe and possibly even beneficial with respect to immunomodulation and attenuation of disease progression.

Will cannabis increase my insulin resistance risk?

Although insulin resistance risk is elevated in people living with HIV, preliminary evidence suggests that cannabis may reduce insulin resistance risk.   More research is needed.

Will cannabis use make me more likely to skip my anti-retroviral therapy (ART)?

Evidence in this regard is mixed, but suggests that use of medical cannabis to treat particular HIV-related symptoms, and especially nausea, either does not impact or may even improve ART adherence; cannabis dependence, however, may decrease ART adherence.  One survey found that people who used medical cannabis to treat HIV symptoms were more likely to adhere to their ART regimens than people with HIV who did not use cannabis, but that those who used marijuana overall were less ART compliant than non-users.   A similar study found that among HIV-positive people with nausea, cannabis use increased ART adherence while among those without nausea cannabis decreased ART adherence.  Two studies found cannabis use to have no effects on ART adherence among people living with HIV,  while a third study found that cannabis use did not affect ART adherence but that cannabis dependence lowered ART adherence.  Three additional studies which made fewer distinctions found no association between cannabis use and ART non-adherence, while two studies found an association between cannabis use and increased ART non-adherence.

Will cannabis negatively affect my neurocognitive functioning?

This is the area of greatest concern, as evidence regarding the impact of cannabis use on neurocognitive performance in people living with HIV is conflicting.  There is some indication that cannabis use and positive HIV status are both associated with reduced neurocognitive performance.  However, neurocognitive impairment is problematic mostly in HIV patients with symptomatic disease and significant immunocompromise; in advanced disease stages, marijuana use and HIV may have synergistic effects on neurocognitive function.  It should also be noted that in general population research, neurocognitive impairment associated with marijuana use appears to be dose dependent and to resolve approximately one month after use is stopped.  Using the smallest amount of cannabis necessary to treat symptoms, and if necessary, occasionally weaning from medical cannabis use in order to re-sensitize the body to the effects of small doses, is generally advised.

In summary, evidence seems to suggest that cannabis may be especially helpful for HIV patients suffering from nausea, GI disturbance and sensory neuropathy, and have ancillary positive effects on mood, anxiety and sleep.  Further, to allay concerns, research suggests that cannabis will either have no effect or possibly even be beneficial with respect to HIV disease progression, and that cannabis use to treat specific HIV symptoms will not harm compliance with anti-retroviral therapy although cannabis abuse may harm such compliance.