AIDS/HIV

HIV stands for human immunodeficiency virus (HIV) that, as the immune system is progressively destroyed, can develop into acquired immune deficiency syndrome (AIDS).

There are two species of lentivirus (a subgroup of retrovirus) that cause HIV infection. HIV infects helper T cells (cells that activate other immune cells to fight infection). Specifically, HIV infects CD4+ T cells, which can create HIV “reservoirs” (which is why the infection is currently incurable), as well as macrophages and dendritic cells.

In 2022, there were 31,800 estimated new HIV infections in the U.S., and the rate was 11.3 per 100,000 people. There are two types of HIV: HIV-1 and HIV-2, with HIV-2 having a lower transmission rate, but being harder to treat.

Antiretroviral therapy (ART) is the most common treatment for HIV and AIDS. Medical cannabis may be useful as an adjunctive therapy for HIV/AIDS patients, and can be used to mitigate medication and disease side effects, such as chronic pain, nausea, and appetite loss.

HIV/AIDS causes

HIV is most commonly spread via unprotected sex. It can also be spread through contaminated blood transfusions, sharing needles, and transmission from mother to child during pregnancy, delivery, or breastfeeding. AIDS usually develops during late-stage HIV.

HIV/AIDS symptoms & health effects

Symptoms of HIV/AIDS include:

• Chronic pain, especially muscle pain and neuropathic (nerve) pain
• Fever
• Fatigue
• Gastrointestinal (GI) issues
• Headaches
• Increased risk of infection
• Mouth sores, including yeast infections (thrush)
• Nausea/vomiting
• Night sweats
• Sore throat
• Swollen lymph glands
• Weight loss

HIV/AIDS diagnosis

The most common (and accurate) way of diagnosing HIV/AIDS is by a blood test or a point-of-care test, in which a saliva and/or blood sample is taken and sent to a laboratory for testing.

Laboratory tests are usually counting for CD4 t-cells. The normal range is between 500 to 1500 cells/mm3. Those with HIV/AIDS will have lower CD4 t-cell counts without ART.

It’s possible to get a home-sampling or testing kit, in which a blood or saliva sample can be taken and sent to a laboratory, or tested at home. However, some home-testing kits are more reliable than others, so blood-testing by a professional is ideal.

HIV/AIDS prognosis

Should HIV be diagnosed early, ART treatment can take place sooner, meaning that AIDS-related illnesses are less likely to occur and the patient will live a near-normal lifespan. However, some studies show that there is an eight-year gap in lifespan between those who are HIV positive and HIV negative.

Those with a high CD4 count and undetectable viral load have much higher life expectancies than those with low CD4 counts and high viral loads. Those who undergo ART treatment generally have a much longer lifespan than those who do not.

HIV/AIDS treatments

AIDS and HIV are treated with antiretroviral drugs. There are 24 FDA-approved drugs available for the treatment of HIV-1 infections. These drugs are separated into six classes:

1. Nucleoside-analog reverse transcriptase inhibitors (NRTIs), aka nucleoside analogs
2. Non–nucleoside reverse transcriptase inhibitors (NNRTIs)
3. Integrase strand transfer inhibitors (INSTI)
4. Protease inhibitors (PIs)
5. Fusion inhibitors
6. Coreceptor antagonists

Examples of antiretroviral drugs include abacavir, emtricitabine, tenofovir, efavirenz, etravirine, and nevirapine.

First-line treatments

The initial antiretroviral treatment regimen for a person with HIV generally consists of:

• Two NRTIs, usually abacavir/lamivudine (ABC/3TC) or either tenofovir alafenamide/emtricitabine (TAF/FTC) or tenofovir disoproxil fumarate/emtricitabine (TDF/FTC)
• A drug from one of three drug classes: an INSTI, an NNRTI, or a boosted PI.

Other treatments

Should first-line ART treatments prove ineffective, other ART treatments may be utilized. Dolutegravir (DTG) has been recommended by the World Health Organization (WHO) for use in second-line antiretroviral therapy (ART). Different combinations of ART may also be used – for example, a boosted protease inhibitor (bPI), plus two nucleoside analogues (NRTIs). Another example is a combination of Atazanavir / ritonavir (ATV/r) or Lopinavir / ritonavir (LTV/r).

Adjunctive therapy & alternative treatments

Although ART is generally very effective, some may decide to supplement their treatment with yoga and massage therapy to help manage pain, stress, anxiety, and depression. Massage therapy may have a positive effect on immunological function, but more studies with larger sample sizes are needed to confirm.

Cannabis for HIV/AIDS

While the treatments we have for HIV/AIDS have proven to be quite effective, not everyone can tolerate them, and even if a person can, the side effects of these medications can prove to be debilitating. Cachexia (wasting syndrome, or sudden weight loss), nausea & vomiting, peripheral neuropathy, and joint and muscle pain are side effects of the disease and some medications. The medical use of cannabis could help with all of these symptoms.

Terpenes and terpenoids are also being investigated for their potential anti-HIV activity. Cannabis may control inflammation in those with AIDS/HIV. It mayeven slow the progression of HIV to some extent, with some studies showing that medical cannabis can suppress HIV viral replication.

CBD may inhibit the growth of certain types of herpes virus, which can help if a person living with AIDS has multiple infections.

However, there are some potential risks to using cannabis to manage HIV/AIDS, including:

• Cannabis that isn’t grown according to high standards may contain pathogens that cause an infection
• “Dry” or “cotton” mouth – a common side effect of AIDS/HIV treatment — may be exacerbated by cannabis use
• Cannabinoids may further suppress the immune system
• Cannabis smoke may irritate the throat and lungs, and recovering from these injuries takes longer with AIDS/HIV
• Some studies show that cannabis may increase HIV viral load, although a national cohort study shows no relationship between cannabis use and HIV viral load

Additional information for patients

There is plenty of support available for HIV/AIDS patients, and each state has its own hotline managed by the HRSA Ryan White HIV/AIDS Program.

There are also a number of international, national, state, and city-wide charities such as AIDS United, Black AIDS Institute, The Joint United Nations Programme on HIV/AIDS, and the San Francisco AIDS Foundation (SFAF). These charities have a number of different functions, from providing medications and research,to raising awareness and providing support services.

FAQs

How long can you live with HIV?

Providing that a person is diagnosed and treated early, those living with HIV can expect to live as long as those without HIV, although some studies do note a reduced life expectancy.

As for AIDS, one 2016 study notes, based on a population of 32,168 patients:

“Of registered patients, 17.7% were diagnosed at AIDS stage. By June 2016, 27.2% of study population progressed to AIDS, and 8081 (25.1%) of patients died. The survival rate was 88%, 85%, 77%, and 67% for 1, 2, 5, and 10 years, respectively.”

What happens if you are HIV positive?

HIV weakens the immune system and, if left untreated, can develop into AIDS. As the immune system weakens, the patient is at greater risk of contracting infections and developing cancer.

For those with a weakened immune system, even everyday illnesses can prove deadly. Those who are HIV-positive will be offered antiretroviral therapy (ART), which can improve quality of life (QoL) and life expectancy outcomes dramatically.

Can HIV be cured?

There is no cure for HIV or AIDS. Stem-cell transplants are showing promise as a potential cure, but more tests are needed before this becomes a viable option. Currently, the best option is antiretroviral treatment.

Resources

• HIV.gov U.S. Statistics: https://www.hiv.gov/hiv-basics/overview/data-and-trends/statistics
• Therapeutic Effects of Cannabis and Cannabinoids: https://www.ncbi.nlm.nih.gov/books/NBK425767/
• Narrowing the Gap in Life Expectancy Between HIV-Infected and HIV-Uninfected Individuals With Access to Care: https://pmc.ncbi.nlm.nih.gov/articles/PMC5427712/
• Survival rate of AIDS disease and mortality in HIV-infected patients: a meta-analysis: https://pubmed.ncbi.nlm.nih.gov/27349729/
• HIV-1 Antiretroviral Drug Therapy: https://pmc.ncbi.nlm.nih.gov/articles/PMC3312400/
• The benefits of yoga for people living with HIV/AIDS: A systematic review and meta-analysis: https://pmc.ncbi.nlm.nih.gov/articles/PMC6364312/
• Massage therapy for people with HIV/AIDS: https://pmc.ncbi.nlm.nih.gov/articles/PMC6599823/
• Plant-derived terpenoids and analogues as anti-HIV agents: https://pubmed.ncbi.nlm.nih.gov/12570771/
• Oral cannabinoids in people living with HIV on effective antiretroviral therapy: CTN PT028—study protocol for a pilot randomised trial to assess safety, tolerability and effect on immune activation: https://pmc.ncbi.nlm.nih.gov/articles/PMC6340429/
• Marijuana Use and Viral Suppression in Persons Receiving Medical Care for HIV-Infection: https://pmc.ncbi.nlm.nih.gov/articles/PMC5226929/
• Cannabidiol inhibits growth and induces programmed cell death in kaposi sarcoma-associated herpesvirus-infected endothelium: https://pubmed.ncbi.nlm.nih.gov/23264851/
• Self-Reported Cannabis Use and HIV Viral Control among Patients with HIV Engaged in Care: Results from a National Cohort Study: https://www.mdpi.com/1660-4601/19/9/5649
• THC: Study of Its Effect on Viral Load: https://www.natap.org/2000/oct/summer2000_newsletter/thc_101800.htm
• Seventh patient ‘cured’ of HIV: why scientists are excited: https://www.nature.com/articles/d41586-024-02463-w

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