The human immunodeficiency virus is a retrovirus that invades cells in the human immune system, making it highly susceptible to infectious diseases.
Survey data indicates that cannabis is used by as many as one in three North American patients with HIV/AIDS to treat symptoms of the disease as well as the side effects of various antiretroviral medications.[1-4] A study published in 2007 reported that more than 60 percent of HIV/AIDS patients self-identify as "medical cannabis users."[5] Patients living with HIV/AIDS frequently report using cannabis to counter symptoms of pain, anxiety, appetite loss, and nausea.[6] HIV patients with a history of cannabis use are less likely than nonusers to consume prescription drugs such as opioids.[7] A pair of recent studies also report that HIV patients who use cannabis exhibit better neurocognitive performance compared to matched controls[8-9] — a result that is likely because of the anti-inflammatory properties of cannabinoids.[10] Another study has reported that patients who use cannabis therapeutically are three times more likely to adhere to their antiretroviral therapy regimens than non-cannabis users.[11]
A 2008 longitudinal analysis of both HIV-positive and HIV-negative men reported that cannabis use does not adversely impact CD4 and CD8 T cell counts.[12] Other studies indicate that cannabis use may boost immune function in some HIV patients.[13-14] A 2018 study of 198 HIV-infected patients by investigators at the University of California, San Francisco reported, "Heavy cannabis use … in HIV-infected, ART-treated individuals was associated with lower frequencies of activated CD4 and CD8 T cells compared to frequencies of these cells in non-cannabis-using individuals. [… O]ur work suggests that cannabinoids may have an immunological benefit in the context of HIV infection, as lowering the frequency of activated T cells could limit the risk of development of non-AIDS-associated comorbidities."[15]
Among patients co-infected with HIV and hepatitis C, a history of cannabis use is associated with several beneficial outcomes – including lower odds of fatty liver disease[16] and insulin resistance.[17] Cannabis use in HIV patients has not been negatively associated with mortality[18] In fact, a recent five-year longitudinal trial reported that co-infected HIV/hepatitis C patients with a history of cannabis use possess a reduced mortality risk compared to nonusers.[19]
The benefits of cannabis and cannabinoid use in HIV patients have been documented in clinical trials. For example, the results of a 2007 study determined "Smoked marijuana also has clear medical benefit in HIV-positive marijuana smokers by increasing food intake and improving mood and objective and subjective sleep measures."[20]
Separate clinical data has reported that inhaling cannabis significantly reduces HIV-associated neuropathy compared to placebo. Authors of a study published in 2007 reported that inhaling cannabis three times daily reduced patients' pain by 34 percent. They concluded, "Smoked cannabis was well tolerated and effectively relieved chronic neuropathic pain from HIV-associated neuropathy [in a manner] similar to oral drugs used for chronic neuropathic pain."[21]
Researchers at the University of California at San Diego reported similar findings in 2008. Writing in the journal Neuropsychopharmacology, they concluded: "Smoked cannabis … significantly reduced neuropathic pain intensity in HIV-associated … polyneuropathy compared to placebo, when added to stable concomitant analgesics. … Mood disturbance, physical disability and quality of life all improved significantly during study treatment. … Our findings suggest that cannabinoid therapy may be an effective option for pain relief in patients with medically intractable pain due to HIV."[22]
Additional studies are ongoing and some researchers have suggested that cannabis-based medicines may one day "provide a beneficial intervention" and a "novel means to reduce morbidity and mortality in PLWH" [people living with HIV].[23-24]
[1] Woolridge et al. 2005. Cannabis use in HIV for pain and other medical symptoms. Journal of Pain Symptom Management 29: 358-367.
[2] Prentiss et al. 2004. Patterns of marijuana use among patients with HIV/AIDS followed in a public health care setting [PDF]. Journal of Acquired Immune Deficiency Syndromes 35: 38-45.
[3] Braitstein et al. 2001. Mary-Jane and her patients: sociodemographic and clinical characteristics of HIV-positive individuals using medical marijuana and antiretroviral agents. AIDS 12: 532-533.
[4] Ware et al. 2003. Cannabis use by persons living with HIV/AIDS: patterns and prevalence of use. Journal of Cannabis Therapeutics 3: 3-15.
[5] Belle-Isle and Hathaway. 2007. Barriers to access to medical cannabis for Canadians living with HIV/AIDS. AIDS Care 19: 500-506.
[6] D'Souza et al. 2012. Medicinal and recreational marijuana use among HIV-infected women in the Women's Interagency HIV Cohort (WHIS), 1994-2010. Journal of Acquired Immune Deficiency Syndromes 61: 618-626
[7] Sohler et al. 2018. Cannabis use is associated with lower odds of prescription opioid analgesic use among HIV-infected individuals with chronic pain. Substance Use & Misuse 53: 1602-1607.
[8] We-Ming Watson et al. 2020. Cannabis exposure is associated with a lower likelihood of neurocognitive impairment in people living with HIV. Journal of Acquired Immunity Deficiency Syndrome 83: 56-64.
[9] Crook et al. 2020. The neurocognitive effects of past cannabis use disorder in a diverse sample of people living with HIV. AIDS Care 21: 1-10
[10] Wei-Ming Watson et al. 2021. Daily cannabis use is associated with lower CNS inflammation in people with HIV. Journal of the International Neuropsychological Society 27: 661-672.
[11] de Jong et al. 2005. Marijuana use and its association with adherence to antiretroviral therapy among HIV-infected persons with moderate to severe nausea. Journal of Acquired Immune Deficiency Syndromes 38: 43-46.
[12] Chao et al. 2008. Recreational drug use and T lymphocyte subpopulations in HIV-uninfected and HIV-infected men. Drug and Alcohol Dependence 94:165-171.
[13] Abrams et al. 2003. Short-term effects of cannabinoids in patients with HIV-1 infection: a randomized, placebo-controlled clinical trial. Annals of Internal Medicine 139: 258-266.
[14] Fogarty et al. 2007. Marijuana as therapy for people living with HIV/AIDS: social and health aspects. 19: 295-301.
[15] Manuzak et al. 2018. Cannabis use associated with reductions in activated and inflammatory immune cell frequencies in anti-retroviral therapy-treated human immunodeficiency infected individuals. Clinical Infectious Diseases 66: 1872-1882.
[16] Adams et al., 2017. Association of cannabis, stimulant, and alcohol use with mortality prognosis among HIV-infected men. AIDS and Behavior [online ahead of print].
[17] Nordmann et al. 2017. Daily cannabis and reduced risk of steatosis in human immunodeficiency virus and hepatitis C virus co-infected patients. Journal of Viral Hepatitis [online ahead of print].
[18] Patrizia-Carrieri et al. 2015. Cannabis Use and Reduced Risk of Insulin Resistance in HIV-HCV Infected Patients: A Longitudinal Analysis. Clinical Infectious Diseases 61: 40-48.
[19] Santos et al. 2020. HCV-Related Mortality Among HIV/HCV Co-infected Patients: The Importance of Behaviors in the HCV Cure Era. AIDS and Behavior24: 1069-1084.
[20] Haney et al. 2007. Dronabinol and Marijuana in HIV-Positive Marijuana Smokers: Caloric Intake, Mood, and Sleep. Journal of Acquired Immune Deficiency Syndromes 45: 545-554.
[21] Abrams et al. 2007. Cannabis in painful HIV-associated sensory neuropathy: a randomized placebo-controlled trial. Neurology 68: 515-521.
[22] Ellis et al. 2008. Smoked medicinal cannabis for neuropathic pain in HIV: a randomized, crossover clinical trial. Neuropsychopharmacology 34: 672-680.
[23] Ellis et al., 2021. Cannabis and inflammation in HIV: A review of human and animal studies. Viruses [open access journal].
[24] Costiniuk and Jenabian. 2019. Cannabinoids and inflammation: implications for people living with HIV. AIDS 33: 2273-2288.
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