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AIDS

Human Immunodeficiency Virus (HIV) is contracted by passing of body fluids. Once thought to be limited to intravenous drug users and gay men, it is increasingly present in the heterosexual population as well. Additionally, many haemophiliacs are HIV-positive after receiving tainted blood products prior to routine screening being introduced. People with the virus usually go on to contract Aquired Immunodeficiency Syndrome (AIDS). The patient's diagnosis changes when either their T-cell count (the number of healthy immune cells the patient has) falls below 200 (normal range is 800-1200) or they contract one of the 30 separate AIDS diseases. These are mostly common "opportunistic infections" that prey on weakened immune systems. Testing HIV-positive is not a death sentence, as by living healthily people can anticipate a life span of 10 years or many more.

Antiviral drugs, of which the best known is AZT, are used to attack HIV. Unfortunately, AZT suppresses the production of red blood cells, decreases the number of white blood cells, and has many damaging effects on the digestive system. It sometimes causes severe nausea that heightens the danger of semi-starvation for patients who are already losing weight because of the illness. About 20% of AIDS patients develop an infectious disease of the eye that can cause blindness. A drug called Foscavir is used to treat it, but this too has the side effect of nausea. The anti-emetic properties of cannabis indicate that it is likely to be useful in treating the nausea caused by the disease and these other medications.

Patients with AIDS suffer from 'wasting syndrome', which is defined by the (US) Centers for Disease Control as 'the involuntary loss of more than 10% of baseline average body weight in the presence of diarrhoea or fever of more than 30 days that is not attributable to other disease processes' . This can occur by either starvation or cachexia, and chances of survival decrease significantly for the patient if as little as 5% of their body weight is lost. Existing therapy for wasting syndrome is the use of appetite stimulants (such as megestrol acetate) but few medications have proven successful. Cannabis too is an appetite stimulant (as can be seen in the 'munchies' that recreational users often get).

In America, oral synthetic THC is available medically, under the trademark Marinol. Its license includes its usage as an appetite stimulant in AIDS patients. An amendment to the Misuse Of Drugs Regulations in 1995 means that it can be prescribed on a named-patient basis in the UK as well, however in practice it is not available, perhaps due to the large amount of administration, regulation and paperwork needed to be done in order to use it medically.

Some concern has been shown as it seems possible that cannabis may suppress the immune system. However, it is not known whether this occurs in humans at the required dosages. If immuno-suppression occurs however, it does not seem severe enough to preclude the use of cannabis as a medicine. Certainly there is no evidence that cannabis use increases the rate of progression to AIDS from HIV-positive patients.

All in all, from both research and anecdotal evidence, cannabis seems to reduce any nausea, appetite suppression and physical pain that comes from either the disease itself, or its currently-prescribed medications.

For the complete collection of testimonies from medical users of cannabis, see our medical testimony database.

As yet, there is not much published information about the efficacy of either cannabis or its derivatives for the treatment of wasting syndrome (or indeed anything) in HIV-positive patients. Clinical trials are beginning in the University of California, under Dr Donald Abrams to establish the safety of cannabis in HIV-positive populations. These trials also look at whether or not cannabis intake interferes with the effects of the protease inhibitors currently used as medications.

Several studies have been done on healthy (HIV-negative) populations however, including those by Foltin et al, and Mattes et al. Typically, they show a resultant increase in body weight, appetite and thus food intake. Likewise in 1997, a National Institutes of Health workshop showed a 'strong relationship' between the usage of cannabis and increased eating. As Gieringer reports, since the 1970s evidence has shown the ability of cannabis to increase appetite and thus induce weight gain in people.

As Marinol (synthetic THC, Dronabinol) has been approved in America since 1992 as a medication to treat AIDS-related wasting syndrome there is a significant body of evidence showing its safety and efficacy in HIV-positive patients. Plasse et al found that 70% of patients gained weight after being treated with Marinol. Dronabinol has been shown to have 'significantly reduced nausea, prevented further weight loss and improved patients' mood' according to a House of Lords report. Indeed, Dr Robson gave evidence for the report suggesting that AIDS-related illnesses are 'the most compelling indication' for cannabis-based medicines.

Two studies by Beal et al showed that when treated with Dronabinol patients gained an increased appetite and a stable weight, both in the short-term and after long-term medication. A study by Struwe et al showed that after 5 weeks of medication with Dronabinol, patients had an increase in body fat of about 1%.

Beal JE, Olson RLL, Morales JO, Bellman P. Yangco B. Lefkowitz L, Plasse TF, Shepard KV. (1995) Dronabinol as a treatment for anorexia associated with weight loss in patients with AIDS. Journal of Pain and Symptom Management 10:89-97.

Beal JE, Olson R. Lefkowitz L, Laubenstein L, Bellman P. Yangco B. Morales JO, Murphy R. Powderly W. Plasse TF, Mosdell KW, Shepard KV. (1997) Long-term efficacy and safety of dronabinol for acquired immunodeficiency syndrome-associated anorexia. Journal of Pain and Symptom Management 14:7-14.

Centers for Disease Control. (1992) 1993 revised classification system for HIV infection and expanded surveillance case definition for AIDS among adolescents and adults. Morbidity Mortality Weekly Report 41 :(RR- 17): 1 - 19 .

Foltin R.W., Brady J.V., & Fischman M.W. (1986) Behavioral analysis of marijuana effects on food intake in humans. Pharmacology, Biochemistry and Behavior 25 577-582.

Foltin R W. Fischman M W. Byrne M F. (1988) Effects of smoked marijuana on food intake and body weight of humans living in a residential laboratory. Appetite 11 :1-14.

Gieringer D (1996) Review of Human Studies on the Medical Use of Marijuana

Greenberg I., Kuehnle J., Mendelson J.H. & Bernstein J.G. (1976) Effects of marihuana use on body weight and caloric intake in humans. J. Psychopharmacology (Berlin) 49 79-84.

Grinspoon L, Bakalar JB. (1993) Marijuana, the forbidden medicine. New Haven: Yale University Press

Hollister L.E. (1971) Hunger and appetite after single doses of marihuana, alcohol and dextroamphetamine. Clinical Pharmacology and Therapuetics 12 44-49.

House of Lords Select Committee on Science and Technology (1998) Science and Technology - Ninth report. Science and Technology Committee Publications, UK.

Institute of Medicine (1999) Marijuana and medicine: Assessing the science base. National Academy Press

Mattes Rn, Engelman K, Shaw LM, Elsohly MA. (1994) Cannabinoids and appetite stimulation. Pharmacology, Biochemistry and Behavior 49:187-195.

National Institutes of Health (1997) Workshop on the Medical Utility of Marijuana: Report to the Director. Washington, D.C.

Plasse T.F., Gorter R.W., Krasnow S.H. et al. (1991) Recent clinical experience with Dronabinol. Pharmacology, Biochemistry and Behavior 40 695-700.

Struwe M, Kaempfer SH, Geiger CJ, Pavia AT, Plasse TF, Shepard KV, Ries K, Evans TG. (1993) Effect of dronabinol on nutritional status in HIV infection. Annals of Pharmacotherapy 27;827-31.