From 1981 to Present: Ending the HIV/AIDS Epidemic
By Terri Kroh, PharmD
Edited by Rebekkah Ranallo
December 1st has been recognized as Worlds Aids Day since 1988. Today we join in showing support and respect for people living positively with HIV, and with our community partners serving on this pandemic front line for over 40 years. We honor those who have died of an AIDS-related illness and their families and friends they left behind. Scroll down for tips on medical marijuana therapy for HIV/AIDS treatment, local testing resources, and the impacts of Covid-19 on patients living with HIV/AIDS.
History and Context
The pandemic of 1918 and the HIV/AIDS pandemic have been described by some as “the bookends of the 20th century.” Now we face the COVID-19 pandemic. Within a short period of time, it has reached every corner of the globe, and it has touched every aspect of our lives. All three of these viruses are infectious diseases with a history rooted in fear. We recognize the ongoing HIV/AIDS pandemic during the COVID-19 pandemic.
The HIV pandemic, which began in 1981, is not over. With 1.7 million new infections in 2019, a 23% decline in new HIV infections since 2010, and 38 million people living with HIV worldwide, we live in a time of two parallel pandemics.
The HIV/AIDS pandemic has claimed the lives of over 35 million people since it began four decades ago. HIV stands for human immunodeficiency virus. It is the virus that can lead to acquired immunodeficiency syndrome, or AIDS, if not treated. HIV attacks the body’s immune system, specifically the CD4 cells (T cells), which help the immune system fight.
Medical marijuana and HIV
The medical value of marijuana in HIV/AIDS has been anecdotally documented for decades as is evidenced by AIDS activists and the San Francisco Cannabis Buyers Club. These activists fought with compassion and care to save their friends and family from the HIV virus, and they paved the way for cannabis legalization movements all over the country. Remember though, medical marijuana is not an approved FDA medication. Please consult your physician before incorporating medical marijuana into your regimen.
Patients living with HIV/AIDS report using medical marijuana to counter symptoms of anxiety, weight loss, nausea, and HIV related neuropathy. One study from the Journal of Acquired Immune Deficiency Syndromes reported that patients who use medical marijuana are three times likely to adhere to their antiretroviral regimens.
The Endocannabinoid System and HIV/Aids Potential Mechanism of Action
Cannabinoids interact with both the receptors in the brainstem and the receptors in the enteric nervous system that controls the GI tract stimulating food intake and improving mood.
Activation of the CB1 receptors in the brainstem dorsal vagal complex regulates energy balance and food intake by affecting the basal function.
CBD interacts with serotonin releasing receptors, and doses have been shown to help alleviate both nausea and vomiting.
CBD shows potential in decreasing painful neuropathy
Potential Benefits of Medical Marijuana with HIV
Symptom management
Decrease Pain
Decrease Nausea
Appetite stimulation
Improving the quality of sleep
Improving mood
Decrease inflammation
Anecdotal Dosage from randomized clinical trials, and scientific articles
Appetite stimulation 2.5mg -5mg THC taken one hour before meals
For pain, 2.5mg to 7.5 mg of THC every three to four hours
For sleep, 5mg THC before bed
Neuropathy responds well to high CBD: THC ratios and strains high in beta caryophyllene
For nausea and appetite stimulation, High THC varieties
High Myrcene strains may trigger appetite
Pittsburgh Area Resources
We salute our community partners that provide unwavering patient-centered care, fight to reduce stigma and discrimination, and improve access to testing, prevention, and treatment.
Prevention Point - https://www.pppgh.org/
Conventional Treatment
Currently, there is no cure for the HIV virus. However, the development of antiretroviral drugs has enabled people with access to treatment to live long and healthy lives with HIV.
Antiretroviral drug therapy (ART), if taken as directed, can decrease the viral load to below detectable levels and save lives and prevent illness. Reducing the viral levels to undetectable makes it almost impossible for a person to transmit the virus to someone else. This is called treatment as prevention. There are means of preventing infection in higher-risk individuals, such as pre-exposure prophylaxis or PREP, with a single daily pill. PREP, when taken as prescribed, can prevent people from getting an HIV infection from sex or IV drug use.
HIV and COVID
People living with HIV may have a compromised immune system. If you have a low CD4 count, a high viral load, or have had an AIDS-related illness, your immune system may be low, leaving you vulnerable COVID-19. It is essential to take your medications as prescribed and strive for a medication adherence rate of 90%. For example, if you take one pill a day out of a 30 day supply, and miss more than one day, you drop below 90%. If you are struggling with taking your medications, talk to your health care provider.
Older people living with or without HIV and those living with underlying health conditions should be extra careful.
The coronavirus is not a sexually transmitted disease, but it can be passed by close contact, kissing, and sex.
HIV prevention is still at the forefront of ending one pandemic even during the COVID pandemic. It's a good idea to have a supply of condoms, and if you are taking PREP, keep a 30 day supply on hand. If you stop taking PREP because of physical distancing, make sure you remember how to start and stop it.
If you live with HIV, try to stock up on your ART, make sure your vaccinations are up to date, and take care of your mental and physical health.
2020 has been full of challenges; the hope and commitment that we will soon end this pandemic are never lacking. Know your status.
World Aids Day Events:
AIDS MEMORIAL QUILT VIRTUAL EXHIBITION
https://www.aidsmemorial.org/virtual-exhibition
Listen to powerful voices from two pandemics:
“World AIDS Day 2020: A National Conversation”
December 1 from 10 am to 1 pm
https://www.aidsmemorial.org/wad2020
Resources:
Pre-Exposure Prophylaxis PREP
https://www.youtube.com/watch?v=TR8-3uAuZGo
https://www.youtube.com/watch?v=TR8-3uAuZGo
Getting to undetectable
https://www.youtube.com/watch?v=QCudOrlw5BA
https://www.cdc.gov/hiv/pdf/risk/art/cdc-hiv-art-viral-suppression.pdf
HIV Risk Reduction Tool
https://wwwn.cdc.gov/hivrisk/#
The right way to use a condom
https://www.cdc.gov/condomeffectiveness/male-condom-use.html
Aids Free Allegheny
https://www.aidsfreepittsburgh.org/about.php
References
http://www.unaids.org/en/resources/fact-sheet
https://www.cdc.gov/hiv/group/msm/index.html
https://www.cdc.gov/hiv/group/msm/bmsm.html
https://www.cdc.gov/hiv/statistics/overview/index.html