Almost a third of the HIV-positive patients attending an outpatient clinic in west London have used cannabis to alleviate symptoms associated with HIV infection or treatment, according to a cross-sectional study presented in the April edition of the Journal of Pain and Symptom Management.

Anecdotal reports have claimed that cannabis use can alleviate some of the symptoms associated with HIV, such as poor appetite, pain, anxiety and depression. To assess the extent of cannabis use, researchers from the Chelsea and Westminster Hospital asked patients attending the hospital’s HIV clinic to complete an anonymous questionnaire about their use of cannabis and the effects of the drug on their HIV-related symptoms.

“Despite the fact that cannabis is still illegal, its use for medical purposes appears to be quite widespread,” they write. “A large number of patients reported that cannabis improved symptom control.”

In total, 523 patients completed the questionnaire. Of these, 143 (27%) reported ever using cannabis to improve their symptoms. The majority (71%) only smoked cannabis, with 2% eating and drinking it and the rest combining eating, drinking and smoking the drug. Most patients (55%) took cannabis daily.

When asked why they took cannabis, 54% of the patients replied "to treat symptoms,” and 20% using it to “reduce symptom frequency.” Sixty-six per cent used cannabis to “relieve anxiety” and 52% to “relieve depression.”

However, 85% said that they used cannabis to “aid relaxation” and 43% “for a high.” It is not clear from the study to what extent these proportions overlapped.

Patients using cannabis reported significant improvements in symptoms. The greatest improvement was seen in appetite. Seventy-eight percent of the cannabis users reported a lack of appetite, but 97% of these experienced an improvement after using the drug (p < 0.001).

Forty-five per cent of the cannabis users reported pain, but the drug improved this in 94%. This included muscle pain (94%; p < 0.001), nerve pain (90%; p < 0.001), tingling (85%; p < 0.001) and headache (65%, p < 0.001).

Statistically significant improvements were also reported for nausea (93%; p < 0.001), anxiety (93%; p < 0.001) and depression (86%; p < 0.001), as well as numbness (72%; p < 0.001), weight loss (69%; p < 0.001), tremor (66%; p = 0.004), constipation (50%; p = 0.003), tiredness (40%; p = 0.002) and diarrhoea (36%; p = 0.007).

However, 47% of the cannabis users reported memory loss after taking the drug (p = 0.043).

There were no reported effects of cannabis on weakness or slurred speech.

This study is limited by taking a ‘snapshot’ of cannabis use among a set of patients and using self-report to measure symptom relief. However, it is likely to form the basis of future studies to compare cannabis to other treatments for HIV-related symptoms and to test for interactions with antiretroviral medications. This may pave the way for the use of standardised, legal extracts of cannabis for HIV-positive patients.

“Our sample of 523 patients has the highest response rate and is the largest study of its kind,” write the investigators. “This detailed report of cannabis use for symptom control in a clinically significantly large group of patients can form the basis for more extensive investigations using purified and standardised cannabis extracts."

“These results will be important in the design of a randomised, placebo-controlled clinical trial comparing conventional treatments to cannabis for symptoms of HIV,” they conclude.

Reference

Woolridge E et al. Cannabis use in HIV for pain and other medical symptoms. J Pain Symptom Manage 29: 358-367, 2005.

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