Persistent inflammation presents a significant challenge in the management of HIV, contributing to various other health-related outcomes, including myocardial infarction, neurocognitive impairment, and, in the worst case, death. With a high prevalence of medical cannabis use among individuals living with HIV, there is growing interest in understanding the potential anti-inflammatory properties of cannabis and its impact on inflammation specifically in the population.
A recent article, we share key insights into the relationship between cannabis use and inflammation in PWH, drawing upon existing studies and highlighting areas for further research.
Cannabis & Its Use in People with HIV
The number of PWH who use cannabis is notably higher than in the general population. Many individuals turn to cannabis to alleviate symptoms such as pain, anxiety, and depression. That said, the therapeutic benefits of cannabis can vary widely due to differences in formulations and compositions. Cannabinoids in cannabis like THC (Tetrahydrocannabinol) and cannabidiol (CBD) exhibit potential anti-inflammatory properties, which may be particularly relevant for PWH experiencing persistent inflammation despite their antiretroviral therapy.
Pathophysiology of Persistent Inflammation in HIV
Despite successful suppression of viral replication with antiretroviral therapy, PWH often experiences chronic immune activation and inflammation. This persistence of inflammation is attributed to various factors, including co-infections such as cytomegalovirus and gut dysbiosis. It also disrupts the gut epithelial barrier and perpetuates a cycle of immune activation and chronic inflammation.
Clinical Impact of Increased Inflammation
Elevated levels of inflammatory markers in PWH are associated with adverse health outcomes, including cardiovascular events, neurocognitive impairment, and depression. The chronic activation of immune cells, coupled with the production of neurotoxic cytokines present in the central nervous system, also contributes to cognitive dysfunction and other neurological complications.
The Endocannabinoid System
One of the unique systems that play a crucial role in regulating inflammation and maintaining homeostasis is the endocannabinoid system (ECS). Cannabinoids from cannabis interact with ECS receptors, mainly cannabinoid receptors like CB-1 & CB-2, modulating immune responses and inflammation. This interaction presents a potential avenue for therapeutic intervention to mitigate inflammation.
The system involves a vast network of chemical signals and cellular receptors that are densely packed throughout our bodies and brain. For example, the cannabinoid receptor in the brain – the CB1 – outnumber many of the other receptor types in the brain. They act similar to traffic cops to control the levels and activity of most of the other neurotransmitters. That is how they regulate and control things: by immediate feedback, turning up or down the activity of whichever systems needs to be adjusted, no matter whether it’s hunger, temperature, or alertness.
We also know that ECS plays a critical role in memory and learning activities. The most obvious observation is that one of the main side effects of high doses of recreational cannabis use is the temporary disruption of short-term memory. When the system is down, the memory returns to normal. There have also been some sophisticated studies of how humans acutely respond to the administration of THC.
That said, ECS also plays a role in hunger and fine-tuning weight-loss medications. The drug that blocks the CB1 receptors, is an interesting example of the central role the ECS plays in so many crucial bodily functions. It was developed as an anti-obesity drug. We know this because there is evidence that cannabis gives you ‘the munchies’, so if you block the CB1 receptors it should cause weight loss.
Cannabinoids Are Anti-inflammatory
The reason cannabinoids are so powerful is that both preclinical and clinical evidence suggests that cannabinoids, particularly THC and CBD, hold anti-inflammatory properties. Studies have shown that heavy cannabis users among PWH exhibit reduced frequencies of activated T-cells and decreased levels of proinflammatory cytokines. CBD, in particular, has been identified as a potent anti-inflammatory component of cannabis, with the potential to improve outcomes in disease models.
Effects of Cannabis on Neuroinflammation
In addition to its systemic anti-inflammatory effects, cannabis may also impact neuroinflammation in PWH. Emerging evidence suggests that cannabis use is associated with reduced neurocognitive impairment, possibly through its ability to mitigate neuroinflammation and neurotoxicity. However, further research is needed to elucidate the specific mechanisms underlying these neuroprotective effects.
Read More: Cannabis and CBD’s Potential For Addressing Liver Health Concerns
Conclusion
Lastly, the potential of cannabis to reduce inflammation and improve clinical outcomes in PWH is a promising area of research. As of now, existing evidence highlights the anti-inflammatory properties of cannabinoids and their potential therapeutic benefits. Further studies, including randomized clinical trials, are warranted to establish the efficacy and safety of cannabis-based interventions in the population. The way forward is to gain more information and develop a deeper understanding of the interplay between cannabis, inflammation, and HIV.
