A large portion of HIV infected Americans were marijuana users before becoming infected.  Thus, it is not surprising that many continue to use it after the infection.  Although the research evidence is clear that marijuana is an important cause of depression and psychosis, many HIV infected individuals report using it for anxiety and depression.  This situation is similar to tobacco where a large portion of tobacco users report that tobacco calms their nerves even though the evidence is clear that tobacco made them more nervous in the first place and if they abstain from tobacco, after suffering a couple weeks of withdrawal, they will experience on average only half the level of anxiety that they experience as tobacco users.

Marijuana Use Common in HIV Infected: In a San Mateo, California, study of 228 HIV infected individuals, the overall prevalence of smoked marijuana in the previous month was 23%. Reported benefits included relief of anxiety and/or depression (57%), improved appetite (53%), increased pleasure (33%), and relief of pain (28%). Recent use of marijuana was associated with severe nausea (odds ratio [OR] = 4.0) and recent use of alcohol (OR = 7.5). No associations between marijuana use and pain symptoms were observed. Patterns of marijuana use among patients with HIV/AIDS followed in a public health care setting. Prentiss D, Power R, Balmas G, Tzuang G, Israelski DM. J Acquir Immune Defic Syndr. 2004 Jan 1; 35(1): 38-45. Ed: Marijuana has been proven to be a common cause of depression in high school students.  Tobacco smokers often say that tobacco calms their nerves and yet tobacco smokers are much more nervous and depressed than non-smokers.  Within weeks of stopping smoking, the anxiety levels of tobacco smokers start decreasing.  In my own practice, a patient smoking marijuana twice a week for appetite reported much better results after I substituted doxepin 25 mg at bedtime in place of the marijuana.

Marijuana Use Associated with Missing Medications: In a study of 255 men and women living with HIV and receiving antiretroviral therapy, those who missed at least one dose of their medications in the past week scored significantly higher on a hopelessness scale and reported more current use of marijuana. People who had been non-adherent also reported significantly more sex partners, greater rates of unprotected vaginal intercourse, and less protected sex behaviors including less protected sex with partners who were HIV negative. Univ. Connecticut. HIV treatment adherence and unprotected sex practices in people receiving antiretroviral therapy. Kalichman SC, Rompa D. Sex Transm Infect. 2003 Feb; 79(1): 59-61

A Treatment for Wasting: Ketotifen, an antihistamine approved in Europe, is a TNF inhibitor. Anabolic steroids are testosterone derivatives designed to increase strength and muscle. Preliminary data from a study combining ketotifen and oxymetholone showed that 18 out of 22 patients gained an average of 11.4 pounds after treatment of an average of 3.9 weeks. Other therapies for wasting. Smart T. GMHC Treat Issues. 1995 May; 9(5): 7-8, 12

HIV Positive Gay & Bisexual Men Heavy Drug Users: In interviews in 12 U.S. states with 9735 gay and bisexual men with HIV infection or AIDS who completed a 45-minute interview, nearly one third reported possible alcohol abuse. Large proportions also reported the use of marijuana (51%), noninjected cocaine (31%), and crack cocaine (16%) in the 5 years before the interview. Smaller proportions, but still much more than the national average, reported ever having injected cocaine (13%), stimulants (8%), and heroin (8%). Geographic differences in noninjection and injection substance use among HIV-seropositive men who have sex with men: western United States versus other regions. Supplement to HIV/AIDS Surveillance Study Group. Sullivan PS, Nakashima AK, Purcell DW, Ward JW. J Acquir Immune Defic Syndr Hum Retrovirol. 1998 Nov 1; 19(3): 266-73

No Impact on Mortality in the Young: 65171 Kaiser Permanente Medical Care enrollees, aged 15-49, had an average of nine years of follow-up. Compared with nonuse or experimentation (lifetime use six or fewer times), current marijuana use was not associated with a significantly increased risk of non-acquired immunodeficiency syndrome (AIDS) mortality in men (relative risk [RR] = 1.12) or of total mortality in women (RR = 1.09). Current marijuana use was associated with increased risk of AIDS mortality in men (RR = 1.90), an association that probably was not causal but most likely represented uncontrolled confounding by male homosexual behavior. Marijuana use and mortality. Sidney S, Beck JE, Tekawa IS, Quesenberry CP, Friedman GD. Am J Public Health. 1997 Apr; 87(4): 585-90. Ed: While this is an interesting study, members of this study were quite young. If marijuana increases cancer and heart disease, a study on such a young population may not detect the increase.  Also, users most adversely affected by marijuana may be more likely not to be able to obtain a job with insurance coverage or to lose their jobs and their insurance coverage leaving those less severely affected to be measured in the study.

Marijuana Before Sex a Risk Factor for STDs: A Jamaican national sample of 2 580, aged 15-49 indicated that more persons who smoked marijuana before sex had a history of STD infections than non-marijuana smokers, the difference was significant among men (46% vs 26%, p < 0.001) but not among women (19% vs 8%, p = 0.09). There was no difference in age, however, more of the smokers were unmarried, poorly educated and unemployed than persons who did not smoke marijuana before sex. They were also more likely to engage in high risk sex behaviors. The results of multiple logistic regression analyses indicated that marijuana smoking before sex was an independent risk factor for STDs among men (Odds Ratio = 2.0, p = 0.04). Characteristics of Jamaicans who smoke marijuana before sex and their risk status for sexually transmitted diseases. Simeon DT, Bain BC, Wyatt GE, LeFranc E, Ricketts H, Chambers CC, Tucker MB. West Indian Med J. 1996 Mar; 45(1): 9-13

Thomas E. Radecki, M.D., J.D.

modern-psychiatry.com

Email: [email protected]