Marijuana and HIV

Marijuana (cannabis), a naturally occurring herb with two active constituents, D9-tetrahydrocannabinol (THC) and cannabidiol (CBD), has been recognized for its medicinal properties for centuries. Marijuana is the most used of all illicit substances. Marijuana use is more common among people living with HIV/AIDS (PLWH) than the general population. It has been shown to have some therapeutic effects in PLWH, including stimulating appetite, reducing anxiety, providing analgesia, and mitigating neurologic and behavioral health symptoms. However, it also has many negative neurocognitive effects. Here, we describe how THC/CBD interacts with human metabolic and immunologic pathways and affect the efficiency of acquiring HIV infection, persistence of viral load, and chronic inflammation. We also discuss therapeutic applications of THC/CBD to several syndromes common in HIV patients, including HIV-associated neurologic decline, liver fibrosis and co-infection with viral hepatitis, cardiovascular disease, and behavioral health symptoms. Finally, we review the evidence of marijuana’s impact on patient’s adherence to their antiretroviral medications and the likelihood of achieving process measures along the HIV care continuum.