In Western industrialized nations, the “Acquired Immune Deficiency Syndrome” – AIDS for short – is no longer a death sentence. The disease is caused by the human immunodeficiency virus (HIV) and can be well controlled with medication: Those who receive timely and regular treatment with antiviral agents can now expect an average life expectancy with a good quality of life. Cannabinoids can support, alleviate symptoms, and help against the side effects of therapy.
Global significance of the disease HIV/AIDS
Although the replication of HIV in the human body can be slowed down by antivirals, the disease remains a global challenge. Worldwide, approximately 37.7 million people lived with HIV in 2020 . Of these, two-thirds live in sub-Saharan Africa. This is also where the association with the Corona pandemic is most striking: studies from England and South Africa suggest that people living with HIV are twice as likely to die from covid-19. Moreover, by mid-2021, the largest proportion of those with a HIV infection worldwide did not have access to Covid vaccines .
Drugs keep the HI virus in check
In Germany, about 91,400 people were living with a HIV infection at the end of 2020. 79,300 affected persons were treated with antivirals . Antiviral drugs represent the core of treatment – they suppress the reproduction of the virus in the body. Usually, several drugs are combined (“combination therapy” ), and a total of about 20 different antiviral drugs are available.
Antivirals differ in their mode of action:
– Some drugs ensure that the virus cannot enter human cells in the first place.
– Other substances ensure a stable defense within the cells.
– Another group prevents the virus from reproducing.
As a rule, those affected take one to two tablets a day. It is important that treatment begins at an early stage and is carried out in a specialized practice or outpatient clinic. It is also essential to take the medication regularly. Blood controls take place approximately every three months. Two parameters are particularly informative:
Viral load: this refers to the number of virus copies per millimeter of blood plasma. The more the HI virus multiplies, the more the immune system has to fight. The aim of antivirals is to reduce the viral load to such an extent that HIV can no longer be detected using standard methods. Even with a viral load of less than 200 viral copies per millimeter of blood, those affected are no longer sexually infectious.
The viral load fluctuates from time to time: At the beginning of the infection, it is quite high in most cases, but decreases with successful therapy. Infections or vaccinations can lead to a short-term increase in viral load.
Helper cells: These markers provide information on how severely the immune system has already been damaged by the infection. The fewer helper cells present, the more susceptible a person is to certain infections. HIV-infected people whose blood has fewer than 200 helper cells per milliliter of blood have an increased risk of so-called AIDS-defining diseases.
Those who are infected with HIV but do not consistently follow the antiviral therapy weaken their immune system immensely. This leads to the so-called “full-blown AIDS”, with life-threatening diseases such as pneumonia, fungal infections of the upper respiratory tract, tuberculosis, or cervical carcinoma.
A good life despite HIV infection
Although the progress in therapy is enormous, an infection with HIV is still not curable today. Nevertheless, with targeted treatment, an almost normal life is possible. Especially young patients can expect an average life expectancy. This is confirmed, among other things, by a meta-analysis of the University of Bristol from 2017 : between 1996 and 2013, the life expectancy of a 20-year-old man who is HIV-positive and receives antiretroviral treatment increased by ten years. For a woman of the same age, it is still nine years.
Data from North America and Europe were evaluated. The researchers attribute the result to improved efficacy and tolerability of the drugs over time, as well as increased compliance among those affected. In addition, there is less resistance to the drugs. Last but not least, prevention and screening, e.g. for cancer and cardiovascular diseases, have also improved – as has treatment for HIV-associated health problems.
Medical cannabis and AIDS
Medical cannabis has no direct influence on HIV infection and the course of the disease itself. However, as a treatment for certain symptoms or side effects of therapy, cannabinoids do have their uses. For example, a study by London researchers concluded that cannabis increased appetite (97 percent of respondents) and improved muscle pain (94 percent), nausea (93 percent), nerve pain (90 percent), anxiety (93 percent), paresthesia (85 percent) and depression (86 percent) .
Other research shows improvement in nausea with medical cannabis therapy . In addition, the effect of medical cannabis on depression and sleep disorders  has been scientifically confirmed.
Finally, cannabinoids are used in the reduction of symptoms of so-called AIDS-defined diseases. First and foremost is cachexia, an uncontrollable weight loss. Cachexia occurs in the context of chronic viral infections, but also in autoimmune diseases or cancer. Patients suffer, for example, from reduced muscle strength, a lowered fat-free mass index, fatigue, loss of appetite and changes in the blood count . Today, research assumes that inflammatory processes lead to irritations in the energy supply of the human body. As a rule, food intake is reduced, but resting energy consumption (“basal metabolic rate”) is increased. The result is a negative energy balance – those affected lose weight because more energy is consumed than supplied.
Tetrahydrocannabinol has appetite stimulating effect
The endocannabinoid system is responsible for controlling food intake, energy balance and metabolism in the human body. Tetrahydrocannabinol (THC), the psychotropic active ingredient of the cannabis plant, has an appetite-stimulating effect and stimulates the human reward system. The background: THC produces endorphins in certain cells, which increase the desire for food and the pleasure of eating . Because of this principle of action, therapy with medical cannabis can help people suffering from cachexia to have a better appetite and quality of life.
The complex inflammatory processes associated with cachexia have not yet been conclusively investigated. Nevertheless, recent studies  are encouraging: In 2015, a team of researchers concluded in a meta-analysis that dronabinol (THC) and medicinal cannabis flowers led to weight gain in people suffering from HIV compared to a placebo.
Supportive treatment for HIV infection
Anyone who wants to do something for their immune system in addition to antiretroviral therapy has many options: For example, sports and exercise strengthen the body’s own immune system. Moderate endurance sports such as swimming, nordic walking, jogging, rowing or, in winter, cross-country skiing are particularly suitable. Stress reduction – e.g. through relaxation practices – also has a balancing effect and strengthens the body’s defenses.
Aids/HIV: still a lot of education needed
In 1988, the WHO proclaimed the first World AIDS Day. Since then, every December 1, various organizations around the world have commemorated the issue of AIDS and called for solidarity with HIV-infected people and their families.
The fact that there is still a great need for education even after forty years with the immunodeficiency disease is shown by the motto of World AIDS Day 2021: “End inequalities. End AIDS. End Pandemics.”  The organizers deplore the discrimination and stigmatization of those affected and, on a global level, the lack of access to medication.
 Aids-Geschichte als Gefühlsgeschichte | APuZ (bpb.de). (Zugriff am 08.02.2022)
 HIV Geschichte: rückblickende Informationen / LIEBESLEBEN (Zugriff am 08.02.2022)
 Aus „Gib AIDS keine Chance“ wird „LIEBESLEBEN“ | Deutsche Aidshilfe (Zugriff am 08.02.2022)
 Fact sheet – Latest global and regional statistics on the status of the AIDS epidemic. (unaids.org) (Zugriff am 08.02.2022)
 HIV-Zahlen und AIDS-Statistik in Deutschland und weltweit (aidshilfe.de) (Zugriff am 08.02.2022)
 Behandlung von HIV ist möglich und erfolgreich | Deutsche Aidshilfe (Zugriff am 08.02.2022)
 Fast normale Lebenserwartung für Menschen mit HIV dank medizinischem Fortschritt | Deutsche AIDS-Hilfe (aidshilfe.de) (Zugriff am 08.02.2022)
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 Welt-Aids-Tag / Welt-AIDS-Tag (Zugriff am 08.02.2022)