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A 2005 survey conducted on 523 HIV-positive patients found that 143 (27%) of the respondents used cannabis to manage their symptoms; of those, an overwhelming 97% reported that they experienced improvements in appetite.
In 2007, a double-blind study was conducted into the effects of smoked cannabis and dronabinol (a synthetic form of THC). This study found that both cannabis and dronabinol increased caloric intake compared to placebo, in a dose-dependent manner. The effect was characterized by increased frequency of eating occasions.
Furthermore, eating occasions averaged 404 kcal across the board, but dronabinol and cannabis caused a significant shift in distribution of nutrient intake–when given placebo, patients derived 51% of their nutrients from carbohydrates, 36% from fat, and 13% from protein; when given dronabinol, fat consumption increased to 40% and carbohydrate consumption decreased, and when given cannabis, protein consumption dropped to 11% while fat consumption tended to increase.
When given high doses of cannabis and dronabinol, patients experienced significant increases in body weight. Under placebo conditions, the respondents’ mean weight was 77.5 kg; after four days of cannabis, patients gained 1.1 kg, and after four days of dronabinol, patients gained 1.2 kg.
Nausea is a common symptom of HIV infection, and as the disease progresses, the causes of the nausea can become increasingly complex. Nausea may arise due to gastrointestinal issues, hepatorenal dysfunction, central nervous system disorders, or as a result of treatments used to treat the disease.
The ability of cannabinoids and certain synthetic analogues to counter the symptoms of nausea in HIV/AIDS patients is well-known; indeed, the THC analogue dronabinol is approved by the US Food & Drug Administration for the treatment of nausea and appetite loss associated with cancer and HIV. An early study into the dronabinol as a treatment for AIDS-induced appetite loss was published in 1995, and found that patients experienced an average 20% improvement in nausea.
The previously-mentioned 2005 patient survey found that 93% of HIV-positive cannabis users reported subjective improvements in nausea after smoking. Another 2005 study found that among HIV-positive patients experiencing nausea, those who used cannabis were more likely to adhere to their anti-retroviral therapies than non-users. Patients not suffering from nausea did not experience significant improvements in adherence if they used cannabis, indicating that adherence was increased by improving symptoms of nausea.
Anxiety, depression and mood disorders are a common feature of HIV/AIDS, and can arise due to a combination of negative physiological, psychological and social pressures. The 2005 patient survey found that 93% of respondents experienced relief of anxiety after using cannabis, while 86% reported an improvement in depression too.
The above-mentioned 2007 double-blind study into cannabis and dronabinol found that both substances improved respondents’ mood and caused a “good drug effect” that increased feelings of friendliness, stimulation and self-confidence. Interestingly, lower doses of THC seemed to provoke higher rates of anxiety in the subjects than higher doses of THC, or dronabinol at any dose.
HIV/AIDS can cause severe and debilitating pain that arises from various complex sources, including joint, nerve, and muscle pain. A 2011 cross-sectional study on 296 socioeconomically disadvantaged patients found that 53.7% had severe pain, 38.1% had moderate pain, and 8.2% had mild pain; over half the subjects had a prescription for an opioid analgesic. More severe pain was also found to correlate with incidence of depression.
The 2005 patient survey found that 94% of respondents experienced relief from muscle pain as a result of using cannabis; 90% also reported improvement in neuropathy (nerve pain) and 85% in paresthesia (burning, tingling and prickling sensations). The fact that cannabis can provide significant long-term subjective relief of chronic pain in HIV/AIDS sufferers is noteworthy; safer and potentially-cheaper medications that could replace use of opioids in disadvantaged groups could have several positive ramifications, including a decline in opioid-related deaths and increased availability of medicine to those in need.
A specific and particularly common form of pain associated with HIV/AIDS is peripheral neuropathy, in which one or more nerves of the peripheral nervous system (any part of the nervous system outside the brain and spinal cord) become damaged and lead to pain, twitching, paresthesia, muscle loss and impaired coordination. It has been shown that cannabis can help improve symptoms of peripheral neuropathy in HIV/AIDS, as well as in other conditions in which it appears, such as diabetes.
Beyond the above-mentioned subjective reports of reduced nerve pain and paresthesia, several other studies have assessed the ability of cannabis to improve peripheral neuropathy in HIV/AIDS patients. In 2007, a patient survey conducted in the U.S., Puerto Rico, Colombia and Taiwan found that 67 of 450 patients with peripheral neuropathy reported use of cannabis to improve their symptoms.
A randomized placebo-controlled trial also published in 2007 found that pain was reduced by over 30% in 52% of the cannabis-using group and by just 24% of the control group, and that there were no serious adverse effects. The first joint smoked by the cannabis-using patients reduced chronic pain by a median of 72% compared to 15% in the placebo group.
In 2009, a double-blind, placebo-controlled, crossover trial into the effectiveness of cannabis in reducing peripheral neuropathy found that of 28 subjects, neuropathy was reduced by over 30% in 46% of the cannabis-using group and 18% of the control group, and that mood and general functioning were improved by a similar degree throughout the course of the study.