A study of 198 HIV-infected, antiretroviral-treated individuals found that heavy cannabis users had significantly reduced frequencies of activated T cells and inflammatory monocytes, suggesting cannabis use may have a potentially beneficial anti-inflammatory effect in the context of treated HIV infection.
HIV researchers and clinicians; immunologists studying cannabis effects; patients with HIV using cannabis.
Heavy cannabis users had reduced activated T cells and inflammatory monocytes in treated HIV
What the researchers found
Researchers measured immune cell activation in 198 HIV-positive individuals on antiretroviral therapy, categorized by cannabis use level based on plasma THC metabolite concentration.
Heavy cannabis users had significantly decreased frequencies of activated (HLA-DR+CD38+) CD4+ and CD8+ T cells compared to non-users.
Heavy users also had decreased frequencies of intermediate and nonclassical monocyte subsets (inflammatory monocyte types).
Additionally, heavy cannabis users had reduced frequencies of antigen-presenting cells producing interleukin-23 and TNF-α, two pro-inflammatory cytokines.
The authors noted that while clinical implications are unclear, these findings suggest cannabis use is associated with a "potentially beneficial reduction in systemic inflammation and immune activation" in the context of treated HIV.
Why it matters
Chronic immune activation persists in HIV-positive patients even on effective antiretroviral therapy and drives many non-AIDS complications. If cannabis reduces this activation, it could have therapeutic implications for the large number of HIV-positive individuals who already use cannabis.
The numbers in context
198 HIV-positive individuals on ART. Heavy cannabis users had decreased HLA-DR+CD38+ CD4+ and CD8+ T cells, decreased intermediate and nonclassical monocytes, and decreased IL-23 and TNF-α-producing antigen-presenting cells.
How the study worked
Cross-sectional study of 198 HIV-infected, ART-treated individuals. Cannabis use categorized by plasma THC-COOH levels via mass spectrometry (heavy, medium, occasional, non-user). Immune cell phenotyping by flow cytometry.
What this study cannot tell us
Cross-sectional design cannot determine causation. Heavy cannabis users may differ from non-users in ways not measured. Reduced immune activation could theoretically impair needed immune responses. Clinical outcomes (disease progression, infections) were not assessed.
How to read the evidence
Moderate. Objective biomarker-based cannabis categorization and comprehensive immune phenotyping, but cross-sectional design limits causal conclusions.
When this study was published
Published in 2018. Research on cannabis and HIV-related immune activation has continued to develop.
The bigger picture
HIV-related inflammation drives cardiovascular disease, neurodegeneration, and other complications even in virally suppressed patients. The finding that cannabis may reduce this inflammation is intriguing, though the clinical significance remains to be determined.
Questions still open
- Does reduced immune activation in cannabis-using HIV patients translate to better clinical outcomes? Could cannabis be used therapeutically to reduce HIV-associated inflammation? Does the anti-inflammatory effect come at the cost of impaired immune defense?
Common questions
Why do HIV patients have chronic inflammation even on treatment?
Does this mean HIV patients should use cannabis?
Read the original research
Heavy Cannabis Use Associated With Reduction in Activated and Inflammatory Immune Cell Frequencies in Antiretroviral Therapy-Treated Human Immunodeficiency Virus-Infected Individuals.
Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 66(12), 1872-1882
Citation
Manuzak, Jennifer A; Gott, Toni M; Kirkwood, Jay S; Coronado, Ernesto; Hensley-McBain, Tiffany; Miller, Charlene; Cheu, Ryan K; Collier, Ann C; Funderburg, Nicholas T; Martin, Jeffery N; Wu, Michael C; Isoherranen, Nina; Hunt, Peter W; Klatt, Nichole R. (2018). Heavy Cannabis Use Associated With Reduction in Activated and Inflammatory Immune Cell Frequencies in Antiretroviral Therapy-Treated Human Immunodeficiency Virus-Infected Individuals.. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 66(12), 1872-1882. https://doi.org/10.1093/cid/cix1116
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