HIV/AIDS, Weight Loss, and Cannabis
Prior to the development of potent antiretroviral therapy, uncontrolled weight loss was a frequent presentation or complication of HIV and AIDS. This is known as HIV-associated cachexia or AIDS wasting syndrome. This was a significant source of morbidity and mortality for patients, as it increased risk of malnutrition and opportunistic infections, and worsened prognosis. Although modern medical therapies have been very effective at transforming HIV into a chronic condition instead of a death sentence, there are still many who are unable to adhere to appropriate therpaies or don’t respond appropriately. These patients are at increased risk for weight-loss syndrome. In order to maintain optimal health, it is crucial for these patients to prevent weight loss and promote weight gain.
For these patients, nutritional counseling and support, and potentially even appetite stimulants, are crucial to maintaining weight effectively. In 1992, dronabinol (a cannabis-derived product) was approved to assist with appetite stimulation and weight gain for patients with HIV or AIDS. Clinical trials have since demonstrated positive impacts of cannabis-based products (ex: dronabinol), as well as cannabis itself. Patients with HIV or AIDS have demonstrated increased stimulation of appetite and weight gain with dronabinol compared to placebo, as well as other appetite stimulants (ex: megestrol).  A systematic review of multiple studies supported these findings.  It showed that patients using inhaled cannabis (6.6 pounds) and dronabinol (7.1 pounds) gained more weight than patients receiving placebo (2.4 pounds). These effects were also observed to be dose-related, with higher doses providing greater benefit.
Summary and Recommendations
For patients with HIV or AIDS and significant weight loss, the primary therapy is to start antiretroviral treatment. Patients often respond quickly and robustly. However, for those who cannot tolerate therapy or for whom therapy is ineffective, weight maintenance is crucial to providing optimal health. Alternative feeding options, like a surgically placed tube directly into the stomach or intravenous nutritional support, may not only be ineffective, but potentially harmful to patients. Megestrol, one of the most commonly used medications to stimulate appetite and weight gain also has significant side effects, including hypertension, edema (swelling of body parts), and increased risk of blood clots and death.  Given such risks, patients would greatly benefit from a less toxic alternative.
Cannabis, and cannabis-based products like dronabinol, have shown to have positive impacts with significantly less potential toxicity. Given its safety profile, high-quality and regulated cannabis products can provide a relatively-risk free benefit to patients in this situation. It is important for patients, and especially providers, to understand this data in order to provider the best possible outcomes to patients.
1) Whiting PF, et al. Cannabinoids for Medical Use: A Systematic Review and Meta-analysis. Jama. 2015. 313(24): 2456-2473.
2) Lutge EE, Gray A, Siegfried N. The medical use of cannabis for reducing morbidity and mortality in patients with HIV/AIDS. Cochrane Database Syst Rev. 2013. 30(4):CD005175.
3) Ruiz Garcia V, López-Briz E, Carbonell Sanchis R, Gonzalvez Perales JL, Bort-Marti S. Megestrol acetate for treatment of anorexia-cachexia syndrome. Cochrane Database Syst Rev 2013; CD004310.