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Journal of Pain and Symptom Management

Despite the major benefits of antiretroviral therapy on survival during HIV infection, there is an increasing need to manage symptoms and side effects during long-term drug therapy. Cannabis has been reported anecdotally as being beneficial for a number of common symptoms and complications in HIV infections, for example, poor appetite and neuropathy. This study aimed to investigate symptom management with cannabis. Following Ethics Committee approval, HIV-positive individuals attending a large clinic were recruited into an anonymous cross-sectional questionnaire study. Up to one-third (27%, 143/523) reported using cannabis for treating symptoms. Patients reported improved appetite (97%), muscle pain (94%), nausea (93%), anxiety (93%), nerve pain (90%), depression (86%), and paresthesia (85%). Many cannabis users (47%) reported associated memory deterioration. Symptom control using cannabis is widespread in HIV outpatients. A large number of patients reported that cannabis improved symptom control.

Despite the potential health benefits of cannabis use for HIV infection, the relationship between long-term cannabis use and balance disturbances remains unknown. In this study, we compared the prevalence of balance disturbances among HIV+ and HIV− cannabis users, controlling for relevant covariates. We hypothesized that long-term cannabis use in HIV+ individuals might be associated with more severe balance disturbances than in HIV− individuals due to potential neurotoxic interactions between HIV infection and cannabis.

We collected data on HIV disease characteristics including current and nadir CD4 count, plasma viral load < 50 copies/mL (undetectable viral load), duration of HIV infection, historical AIDS status, and current use of ART. We asked about the use of medications commonly associated with balance problems: antihypertensives, sedatives, and opioids. We also collected data on age, gender, race/ethnicity, and education. History of long-term alcohol abuse and diabetes were also reported. Height and weight were measured in order to calculate the body mass index (BMI). Chronic distal sensory polyneuropathy (cDSPN) was diagnosed based on the presence of any of the following abnormal findings in a distal (feet and toes more than calves and thighs), symmetrical distribution during physical examination: reduced sharp sensation, vibration sense, or reflexes.


Among HIV+ individuals, factors related to HIV including positive AIDS status, lower nadir CD4, current ART treatment, and a longer duration of HIV infection were statistically significantly associated with a higher likelihood of balance disturbances (Table 3). Participants on efavirenz (EFV) had a reduced odds of balance problems compared to those on other ARVs (OR 0.652 [0.4840.880]), but an increased risk compared to those off ARVs (OR 1.41 [1.00, 1.97]). The proportion with an undetectable viral load in the entire HIV+ population was 58.6% (58.7% with moderate-severe imbalance vs 58.6% with no or minimal imbalance).

On average, participants were 45.4 years old (SD = 11 years), primarily male (77.7%), and non-Hispanic white (48.1%). A majority of participants were HIV+ (79.1%). Four hundred thirty (11.9%) of the participants reported balance disturbances within the past 10 years. PWH were more likely to have balance disturbances than demographically matched HIV-uninfected participants (odds ratio [OR] 2.66, 95% CI 1.91–3.7). Participants with moderate-severe balance disturbances did not differ from those with no or minimal imbalance in the proportion who had ever used cannabis (73.8% vs. 74.4%; p = 0.8) (OR 1.03, 95% CI 0.80–1.32) neither did they have a higher total amount of cannabis use (4871 vs. 4648; p = 0.3) (Cohen’s d 0.11, 95% CI 0.01–0.14). In the HIV− population, those with balance disturbances reported more total amount of cannabis use as compared to those with normal balance (11316 vs 4154; p = 0.007). In the HIV+ population on the other hand, there was no significant association (4379 vs 4773; p = 0.6).

The study comprised 3664 ambulatory HIV+ and HIV− individuals enrolled in multiple NIH-funded research studies at the University of California, San Diego HIV Neurobehavioral Research Program (HNRP). Participants were enrolled between September 2003 and June 2017, and the most recent evaluation was used for each participant. At the time of enrollment, all participants provided written, informed consent. Secondary data analysis was performed. Inclusion criteria for this analysis included completion of a structured clinical interview which provided details regarding the occurrence of cannabis use and balance disturbances and completion of a neurological examination. The clinical interview and the physical examination were performed on all participants. Exclusion criteria included blindness, being a wheelchair user and experiencing falls as a consequence of sustaining a violent blow, loss of consciousness or sudden onset of paralysis as in stroke or epilepsy. We excluded individuals with other neurologic conditions such as motor neuron disease, Parkinson disease, and multiple sclerosis. Individuals with stroke were excluded only if they had persistent neurological deficits after their stroke. Recognizing that peripheral neuropathy and vestibular disease are common in HIV+ individuals, we did not exclude these conditions. Additionally, urine samples were collected at screening and participants with a positive toxicology report (except for cannabis) were excluded.

Two studies done in animals found that CBD helped with inflammation and neuropathic pain in rodents like rats and mice. There’s also evidence CBD may help with anxiety and insomnia. More research is needed to know if it can do the same for humans.

Choose the purified form. Try to find a source you can trust. And use CBD only instead of marijuana. This will help you get potential health benefits without the “high” caused by THC.

Effects of Marijuana

Check for drug interactions. CBD can keep some medications, like blood thinners, from working the way they’re supposed to. Always check with your doctor before trying CBD as a treatment for your HIV symptoms.

There’s evidence that marijuana helps with HIV symptoms and some side effects of treatment. Scientists are still learning how it works. Most studies are on the entire cannabis plant, not specific chemicals. Here’s what we found.

CBD comes in many forms, from liquid drops to oil to vapes. But the FDA doesn’t regulate most of those products. The only FDA-approved form of CBD oil is Epidiolex, a prescription drug that treats two types of epilepsy. So it’s hard to be sure other CBD products are what they say they are, even if the label looks official. For instance, THC has been found in some CBD products. There’s also no guarantee the product has as much CBD as the label says. CBD can also have side effects. It may cause: