The current medical cannabis movement actually started as a patient’s rights problem during the HIV/AIDS crisis around San Francisco in the 1980s and 1990s. Medicinal cannabis was discovered to alleviate the wasting syndrome in early AIDS patients. It also had the ability to relieve the nausea and appetite suppression side effects of azidothymidine (AZT), the first government approved antiretroviral treatment for AIDS. The United States government tried to ignore and suppress this medicinal use of cannabis whereby they were defeated, due to AIDS activists taking up the cause.
Cannabinoid Research
Cannabis medicines proved to be of great value during the AIDS crisis in helping patients to maintain weight, since cachexia is a significant issue in the treatment of HIV/AIDS (see our article on Cachexia). A study published by the science team at Stanford University, Harvard University, and the Veterans Administration hospital network (VA), revealed that brief cannabis use is positively linked with increased antiretroviral therapy (ART) adherence and relief of common HIV symptoms. Chronic heavy use was associated with low adherence to an ART regimen and the development of negative psychological symptoms. [1] A 2016 New Zealand study showed that cannabis medicines improved mood. [2] Many of the medications used as treatments for HIV/AIDS are known to cause nausea and vomiting in the first few days following administration, but gradually subsides. A 2007 study that was focused on acutely ill AIDS patients showed that cannabis significantly improves appetite and increases caloric intake. [3] In preclinical studies published in 2014, Canadian researchers discovered that the cannabinoids, CBD and CBDA, were effective in treating nausea and vomiting. [4] See our article on Nausea and Vomiting.
Cannabinoid medicines have been used successfully to treat neuropathies related to HIV for over a decade and explored as potential treatments for pain from HIV-related inflammation. In 2007, Dr Donald Abrams produced a small scale human trial showing that inhaled THC-dominant cannabis strains were valuable and very effective in treating painful HIV-related neuropathy. [5] The researchers concluded that smoked cannabis was as potent and effective as orally administered cannabinoids for pain. Severe pain associated with inflammation caused by the HIV infection benefits from the administration of THC, which provides distraction from the pain. Cannabidiol (CBD) and the terpene myrcene can also be of assistance by reducing the perceived intensity of pain. See our articles on Pain, Neuropathy, and Inflammation.
Insomnia is common for people dealing with HIV/AIDS while there is conflicting evidence about whether THC acts as a sedative, it seems to be more potent and soporific if swallowed. This is likely due to the metabolism of delta-9-THC into a more potent form, 11-hydroxy THC, by the liver. On the other hand, research into CBD’s ability to assist with sleep issues has been under intense investigation for almost a decade, which you can read more about in our articles on Sleep Issues, Insomnia, and Liver Health.
A small study looking for potential negative immunological impact on HIV/AIDS patients using medicinal cannabis, proved no additional impact on immune function while using cannabis. Also, drug interaction studies of THC and the combination protease inhibitors used to treat HIV infection found no impact on these protease inhibitors efficacy. [6] Other studies on the effects of tetrahydrocannabinol on the immune function of rhesus monkeys, with simian immunodeficiency virus (SIV), showed monkey’s mortality rate and viral load declined. [7]
The Mechanism
Cannabinoids powerfully interact with both the receptors in the brainstem and the receptors within the enteric nervous system (ENS), which control the gastrointestinal tract (GI). The ENS manages the nausea, vomiting, and appetite responses triggered by HIV/AIDS and the treatments used to manage the illness. [8] Cell studies have also looked at the possibility that new drugs or combinations of plant-based cannabinoids; intended to target the CB2 receptor, may address severe symptoms of neuropathic pain and wasting in HIV/AIDS sufferers, but without the psychoactivity associated with cannabinoids interacting with the CB1 receptor. [9] The terpene beta-caryophyllene targets the CB2 cannabinoid receptor and could also be of value in assisting with the treatment of HIV-related neuropathy. Cannabidiol (CBD), which targets the same CB2 receptor as well as several others, also shows potential as a treatment for neuropathy. See our Ultimate Guide to Terpenes.
History of Cannabis & AIDS
When the AIDS crisis struck San Francisco in 1981, as documented in Clint Werner’s “Medical Marijuana and the AIDS Crisis,” the disease affected prominent gay rights activists, who then become the first AIDS activists. [10] Word soon spread that smoking or eating cannabis often resulted in the “munchies,” helping AIDS patients consume food, reduce nausea and vomiting, and gain much needed weight. AIDS activists aligned with medical cannabis activists, taking on the US government’s insistence that cannabis had no medicinal value. Volunteers like “Brownie Mary” Rathbun visited the San Francisco General Hospital’s AIDS ward, handing out her homemade cannabis edibles to patients. Dr Donald Abrams, at the time the assistant director of the AIDS program at the hospital, witnessed firsthand the number of people benefitting from using cannabis for medical purposes. It wasn’t until 1998, that Abrams finally received permission to conduct the first government-approved study on cannabis and HIV treatment. [11] Unfortunately, by the time Abram’s study was approved by the National Institute of Drug Abuse (NIAD), 410,000 Americans had died of AIDS. California formally embraced the medical marijuana movement with the 1996 passage of Proposition 215 legislation authored by some of the earliest medical cannabis activists, including Dennis Peron. Peron was the founder of San Francisco’s first cannabis buyers’ club, which he modeled on 1980s buyers’ clubs that imported promising drugs from overseas to fight AIDS. [12] [13]
A promising 2018 study showed medicinal cannabis could assist with the neuroinflammation associated with AIDS, [14] and a 2020 study revealed cannabis was associated with lower levels of inflammation in the body and an improved immune response in AIDS / HIV patients. [15]
Medical disclaimer: information contained in this article is intended to be used for informational purposes only and does not constitute medical advice. Prior to making changes to their lifestyle or treatment plan HIV patients should always consult with a doctor. People living with HIV and AIDS can experience symptoms of HIV such as weight loss, vomiting, and other reactive adverse effects characteristic of poor health conditions.
Best Dosage for HIV / AIDS
The key for effective cannabis dosage is to use the smallest effective dose for the symptom being treated.
Oral cannabis is quite effective for stimulating appetite, increasing the quality of sleep and rest, and provides longer-lasting analgesia in HIV/AIDS patients. Taking cannabinoids orally requires some degree of patience and planning to achieve consistent relief over time. This is because swallowed medicines typically take 45 minutes to an hour to take effect, whereas inhaled cannabis products are immediate; with sublingual sprays and tinctures taking around 15-20 minutes to be felt.
Appetite Stimulation
Appetite stimulation generally needs around 2.5 to 5 mg of THC, taken an hour before meals. Many people find the “sweet spot” dose is around 12.5 mg, several times per day to overcome nausea, but inexperienced cannabis users should start with no more than 2.5 mg of THC and slowly titrate the dose upward. Some people discover the importance of increasing this dose up to 20 mg of THC in order to fully stimulate their appetites, especially if accompanied by severe nausea from drug side effects. Many people settle into a dosage routine of around 10 to 12.5 mg two to three times per day, an hour before eating meals. Cannabis psychoactivity generally declines when a dose is maintained, so inexperienced users could discover that side effects tend to diminish within just a few days. A 10:1 or higher ratio of CBD to THC is recommended to control the side effects of higher doses of Tetrahydrocannabinol.
CBD Oil and HIV Related Pain
For neuropathy and pain, 2.5 to 7.5 mg of THC can be consumed orally, every three to four hours. The addition of CBD to the THC dose can reduce the intensity of THC psychoactivity while still giving a measure of neuroprotection. Remember that the cannabis dosage has a sweet spot for pain relief, so it must be stressed that one must avoid overmedication (consuming too much), to avoid exceeding the optimal dose for relief.
Sleep Support
For support with sleep and insomnia, consume 5 mg of THC one hour before bed, swallowing THC increases its soporific (sleep inducing) and analgesic (pain relieving) effects and extends the period of action. Many people report that vaporized or smoked cannabis flowers are effective in treating the neuropathic pain associated with HIV/AIDS and its pharmaceutical treatments. The research shows us that the compounds found cannabis can be of value with regards to CBD oil and HIV.
Neuropathy
For pain/neuropathy, 2.5 to 7.5 mg of vaporized or inhaled THC is typically the recommendation for faster onset than with oral administration. As always, start low and slow with the lowest effect dose to avoid developing a tolerance wherever and whenever possible. You can always take more cannabis, but you can’t take less, so be sure to keep the dose low and titrate your way up. If a tolerance is gained because higher doses have been needed to effectively deal with the nausea, this dose may need to be adjusted upwards also, or the user can potentially stop consuming any cannabis products for 48-72 hours in order to reset the cannabinoid receptors; then starting again at low dose and titrating one's way up once again. Inexperienced users should start with no more than 2.5 mg of THC (about a matchstick-head-sized piece of cannabis flower) and wait 10 to 15 minutes before adding more. Again, cannabis dosage has a sweet spot for pain relief, so caution must be observed to avoid overmedication and to avoid exceeding the optimal dosage for relief.
Best strains for HIV / AIDS
Appetite stimulation and nausea are generally treated with conventional THC cannabis varieties. Neuropathy actually responds better to high-CBD strains, such as Deadlights and ACDC, which can be alternated with high-THC varieties to provide a wider range of effects. High-CBD strains are also of value in reducing symptoms of anxiety and stress. For nausea and appetite stimulation, potent-THC varieties, such as Banana Kush, and OG Kush, and robust strains such as Pincher’s Creek, are recommended. High-myrcene Afghan strains are noted for their tendency to trigger the “munchies.” Blue Dream, with its appealing aroma and strong potency, is an ideal choice for treating nausea.
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1. https://pubmed.ncbi.nlm.nih.gov/23054178/
2. https://pubmed.ncbi.nlm.nih.gov/26929669/
3. https://pubmed.ncbi.nlm.nih.gov/15778874/
4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5576606/
5. https://pubmed.ncbi.nlm.nih.gov/17296917/
6. https://www.researchgate.net/publication/221918671_Cannabinoids_Influence_on_the_Immune_System_and_Their_Potencial_Use_in_Supplementary_Therapy_of_HIVAIDS
7. https://pubmed.ncbi.nlm.nih.gov/20874519/
8. https://pubmed.ncbi.nlm.nih.gov/17566383/
9. https://pubmed.ncbi.nlm.nih.gov/22448282/
10. https://www.tandfonline.com/doi/abs/10.1300/J175v01n03_03
11. https://pubmed.ncbi.nlm.nih.gov/12965981/
12. https://www.tandfonline.com/doi/abs/10.1080/02791072.1998.10399688
13. http://www.sfaf.org/hiv-info/statistics
14. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5790621/
15. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7309527/
