Triumeq and cbd oil
Cannabis has long been known to make adherence to HIV medication bearable. In fact, the virus is one of the foremost qualifying conditions for medical cannabis in the majority of legal states. After all, it was a key driving force in the original crusade to legalize the plant. A growing number of states — not including CBD oil-only states, or states with undefined lists of conditions — explicitly include HIV or AIDS as a qualifying condition for medical marijuana: As of 2019, that includes Alaska, Arizona, Arkansas, California, Colorado, Connecticut, Delaware, Florida, Hawaii, Louisiana, Massachusetts, Michigan, Minnesota, Missouri, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Dakota, Ohio, Oregon, Pennsylvania, Rhode Island, South Carolina, Utah, Vermont, Washington, and West Virginia.
Despite the widespread acceptance of cannabis for alleviating symptoms of HIV, there is much more to be learned about the actual mechanisms of the plant in reducing neurocognitive issues and inflammation — some of the most detrimental effects associated with the virus. People living with HIV often take steroids or other potent drugs that are hard on the kidneys, making it difficult to distinguish what symptoms come from HIV and what symptoms come from HIV drug regimens. HIV drugs powerfully annihilate HIV cells in the bloodstream to undetectable levels, but the virus still reaches the deepest reservoirs in the body, such as in the bone marrow or in the brain, where drugs cannot always reach.
As a person living with HIV, I can affirm cannabis’ ability to noticeably improve the quality of life — especially considering the often toxic HIV drugs that I’m consigned to take daily in order to stay alive. For over three years, I had to take a mandatory daily dose of Atripla — a three-drug pill containing the hallucinogenic drug efavirenz. It was the first drug I was prescribed, and I was casually warned that efavirenz may cause “weird dreams.” On the third day of taking Atripla, I experienced profound hallucinations, much more like a full-blown acid trip than a dream. Then it happened about every three days. Researchers have confirmed the medication’s LSD-like properties.
I consumed or smoked cannabis daily to take the edge off of efavirenz and ‘roid rage caused by testosterone. Consuming cannabis was the only way for me to stay grounded when the hallucinations made it difficult to distinguish reality. It’s also the only thing that works to lower constant digestive irregularity and provide mental clarity, like resetting my brain. While HIV is considered to blame for the cognitive issues, researchers have linked some neurocognitive problems to efavirenz itself.
“Efavirenz commonly causes early neuropsychiatric side effects, but tolerance develops in most patients,” wrote a South African research team in a 2013 study published in Expert Opinion on Drug Safety. “There is emerging evidence that efavirenz use may damage neurons, which could result in impaired neurocognitive performance.” In South Africa, efavirenz is more commonly abused recreationally. This, coupled with HIV, spells bad news for the cognitive abilities of people living with HIV.
Eventually, I got tired of tripping every three days. After three and a half years, I switched from Atripla to a pill called Stribild and then finally Genvoya, which both have fewer side effects. Each time a new pill is released, it is branded as less toxic — as in the case of Genvoya.
Michigan State University was the recipient of a $2.4 million grant from the National Institutes of Health to study how cannabis compounds can reduce inflammation and cognitive problems among HIV patients. Dr. Norbert E. Kaminski is director of Michigan State University’s Center for Integrative Toxicology and a professor of Pharmacology & Toxicology. “A high percentage of HIV patients develop a neurocognitive disorder called HANS (HIV-associated neurocognitive disorder),” Kaminski told MERRY JANE on the phone. “And what causes this, in part, is that there is a chronic inflammatory response in the brain, partly due to the HIV virus getting into the brain. That inflammatory response ultimately causes the damage and destruction of neurons. In the most severe cases, HIV patients can develop symptoms what you would see in Alzheimer’s patients.”
Growing evidence to support the idea that cannabinoids can suppress the progression of HIV is nothing new. “We’ve known for a very long that cannabinoids, including delta-9-THC, can modulate the immune system, but in this case, they are also anti-inflammatory,” Kaminski said. “So some of our preliminary studies which led to the funding of this grant, was that when we began looking at the circulating white blood cells in HIV patients, we found that many of them have very high levels of monocytes [a type of white blood cell], and these monocytes were activated to something they recognized as being foreign. We also saw that in HIV patients that use medical marijuana — they did not have this condition. The number of monocytes in the patients using medical marijuana was very similar to our healthy non-infected controls.”
Kaminski was amazed at the difference in profile in the bloodwork. “So what we are hypothesizing is that we think those individuals that are using marijuana may be able to control the number of these inflammatory monocytes.” He explained that monocytes, when in circulation, become activated and can cross the blood-brain barrier and get into the brain. Once they’re in there, they continue the inflammatory response. They also deplete proteins that recruit additional white blood cells that get into the brain. “By controlling the number of activated white blood cells,” he explains, “we believe that there will be fewer of these cells crossing the blood-brain barrier and potentially also inhibiting or impairing that inflammatory response so that they don’t develop this neurocognitive disorder.”
Cannabis’ status under Schedule I makes it harder for researchers like Kaminski to get things done. Kaminski and his research team don’t give study participants medical cannabis. Instead, they provide them with questionnaires and compare the patients who use medical cannabis to those who don’t. Kaminski’s team also used GB Sciences’ cannabis-based neuroprotective compounds in its research.
The team’s findings could eventually pave the way for future HIV medications. “I would first like to note that the research into cannabinoid-based therapies for treatment of HIV-associated inflammation is very limited,” study co-author Mike Rizzo reiterated via email. “Despite this, I do believe there is potential for the development of cannabinoid-based medicine to dampen the chronic inflammation associated with HIV infection. In our recent publication, we observed that HIV+ individuals utilizing cannabis had a lower level of inflammatory markers in their blood compared to HIV+ individuals who did not use cannabis. This would suggest that cannabis use is lowering the level of inflammation in these HIV+ individuals.”
Rizzo continued. “Furthermore, we have evidence in the lab indicating that THC is a key cannabinoid compound promoting the anti-inflammatory effects that we observed in these HIV+ individuals utilizing cannabis. To conclude, despite the limited research regarding cannabinoid use and inflammation, I do believe there is promise for the development of cannabinoid-based medicine to alleviate HIV-related inflammation.”
Modern HIV drugs, called antiretrovirals, work relatively similar to antibiotics — in the sense that if you skip days of pills, you can develop a resistance and it will eventually render the drug useless. Drug resistance is a consistent major issue for otherwise effective HIV drugs. It’s also one of the reasons why people still die of AIDS today, even though there are now so many effective drug options to choose from. Some people are subject to superinfection with multiple strains of HIV, and others were infected with supercharged multidrug-resistant HIV strains.
Still, I’m grateful for efavirenz and other HIV drugs — I’d be dead by now if effective HIV medicine didn’t exist. Had I been diagnosed 20 years earlier, I’d be forced to take experimental medications like AZT that didn’t work and might even make things worse.
Like innumerable other people around the world, I’ve embraced cannabis to combat the various issues that I faced as a result of my HIV. After being diagnosed, I eventually found a local Long Beach, California dispensary that ran a compassionate care program which gifted a small amount of cannabis every week to people living with HIV or cancer. All I had to do was furnish my diagnosis form and my doctor’s recommendation for cannabis. The budtender there refused to touch my dollars when I bought more cannabis, but overall it was worth it. In California, it’s no secret that cannabis works wonders for HIV.
Things have changed since HIV was the deadly plague it was in the 1980s. People living with HIV who adhere to their medication without skipping days can expect a near-normal life expectancy. With cannabis, however, the quality of life can be greatly improved. I can say this with confidence.
There’s a myriad of ways cannabis can benefit people living with HIV. I can say this from personal experience.
Does CBD Interact or Interfere with Medication? What Arthritis Patients Must Know Now
If you use CBD products, you need to understand how they could interact with the other medications you take.
CBD (cannabidiol) is seemingly everywhere, with oils, tinctures, pills, chocolates, gummy bears, and creams available all over the internet, at national drugstore chains, and perhaps at your local farmer’s market — even if you don’t live in a state where medical or recreational marijuana is legal.
CBD, a type of chemical known as a cannabinoid, is a mainingredient in hemp, one type of cannabis plant. Marijuana, another type of cannabis plant, also has some CBD but an abundance of THC (tetrahydrocannabinol), an intoxicating cannabinoid known for making users feel “stoned” or “high.” While CBD won’t get you high, it interacts with cannabinoid receptors in your body and may have effects that are sought by people with arthritis, such as pain relief, reduced inflammation, and improvements in sleep and anxiety.
According to CreakyJoints research presented at the 2019 Annual European Congress of Rheumatology meeting earlier this year, 52 percent of respondents reported having tried CBD for a medical reason. Of those who did, 93 percent said it helped. More than half said they wanted more information on CBD from their doctor, but 58 percent of those who told their doctors about their CBD use did not get the information on safety, effectiveness, and dosing they were looking for.
One common concern among people with chronic illness who use CBD is whether CBD can interfere with prescription drugs you may take for arthritis or other conditions.
We put commonly asked questions to Nina M. Bemben, PharmD, BCPS, a specialist in drug interactions who is trying to educate other pharmacists about possible drug-drug interactions with CBD, as well as Rachna Patel, DO, a physician who does consultations about medical marijuana and CBD and sells her own line of CBD products.
What kind of drug interactions can happen with CBD?
A huge number of medications, including CBD, are broken down by the same large family of liver enzymes, called CYP450.
CBD inhibits some enzymes in this family. This makes them break down certain drugs more slowly, which could potentially increase side effects unless your doctor adjusts the dose. On the other hand, CBD induces other enzymes in this family, which speeds the breakdown of certain drugs so they may potentially be less effective unless the dose is increased.
As examples, you may experience increased side effects if CBD is used along with these drugs:
- Antidepressants (such as fluoxetine, or Prozac)
- Medications that can cause drowsiness (antipsychotics, benzodiazepines)
- Macrolide antibiotics (erythromycin, clarithromycin)
- Heart medications (some calcium channel blockers)
“There is still a lot of uncertainty about how CBD interacts with drug-metabolizing enzymes in the body. We know that there are some drug-metabolizing enzymes that are affected by CBD, some that are not, and many others where we just don’t have any information yet,” says Dr. Bemben.
What do we know for sure about CBD’s interactions with other drugs?
The most direct information comes from studies on the only FDA-approved CBD product, Epidiolex, which is used to treat rare forms of epilepsy. Epidiolex has been found to increase blood levels of the blood thinner warfarin about 30 percent, which raises the risk of bleeding. It also interacts with other medications used for epilepsy.
“The manufacturer of Epidiolex was asked by the FDA to conduct more drug-drug interaction studies, so we will learn more about CBD’s interactions with other drugs in the future,” says Dr. Bemben.
Can CBD interact with medications I take specifically for arthritis?
“Based on what we know now about the way CBD is metabolized, I would not expect significant drug-drug interactions with drugs commonly used in arthritis treatment, such as methotrexate, and most nonsteroidal anti-inflammatory drugs (NSAIDs). I would advise caution on one NSAID, diclofenac, because there isn’t information on how CBD affects — if at all — the enzyme that metabolizes it,” says Dr. Bemben.
Rheumatologists are always on the alert for liver problems that may result from arthritis medications, and that includes CBD as well as NSAIDs and methotrexate.
Are older people more at risk of CBD drug interactions?
Yes, for several reasons. “As we age, our livers and kidneys may be slower to eliminate drugs from the body. In addition, older patients and those with chronic health problems are more likely to be using multiple medications, so the risk for drug interactions increases,” says Dr. Bemben.
Dr. Patel worries in particular about any side effects or interactions that result in dizziness and may increase the risk of falls in the elderly. For example, using the antidepressant fluoxetine together with cannabis products can increase dizziness and drowsiness.
Are there some people who should stay away from CBD?
Hold off if you have known liver damage, says Dr. Patel. In a study done on mice published earlier this year, the dose of CBD used to protect against seizures was found to induce liver damage. According to other animal research, CBD may increase levels of liver enzymes, raising concerns about liver toxicity in patients taking methotrexate.
“We use other therapies that cause liver injury, like nonsteroidal anti-inflammatories (NSAIDs). If liver enzymes go up in someone on methotrexate, we would generally hold the drug other than methotrexate [for example, CBD or an NSAID] to see if the enzyme levels normalize,” says Michael Weinblatt, MD, professor of medicine at Harvard Medical School in Boston.
People who take Epidiolex for epilepsy are more likely to develop abnormal liver enzymes, as well as sleepiness and other symptoms, if they are also using valproic acid to control seizures.
“This is important for people with arthritis to know because valproic acid is sometimes used for pain that isn’t controlled by other medications,” says Dr. Patel.
If I stick with a CBD cream, does that reduce the risk of drug interactions?
Probably, since little if any of a topical product is likely to be absorbed into your system. “Unfortunately, we just don’t have good information about how much of a topical CBD product gets absorbed. This can be influenced by the inactive ingredients in the product, where on the body it’s applied, and whether you apply a bandage over the area after applying it,” says Dr. Bemben.
While topical CBD products may not be absorbed deeply enough to raise concerns about drug interactions, that also means they may not be as effective for arthritis pain. “If you just have one joint hurting and it’s close to the surface, using a topical would be appropriate. It’s not as likely to help a hip or other deep joint,” says Dr. Patel.
Which health professionals need to know I’m trying CBD?
Tell your rheumatologist and anyone else who prescribes medication for you. If you need surgery, an anesthesiologist may choose a different dose or type of anesthesia if you’re using CBD.
“If you fill all of your medications at the same pharmacy, your pharmacist will be able to assess for drug interactions for all of them, regardless of who prescribed them. You should still let the pharmacist know about over-the-counter medications, herbs, and supplements — including CBD — that you don’t get through the pharmacy. It is important to bring the CBD product to your doctor and pharmacist so they can check the amount of CBD and other ingredients it contains,” says Dr. Bemben.
“While patients may be wary of stigma surrounding CBD products, I believe most health care providers understand this is a growing area and one strategy patients are trying in hopes of getting relief,” she says.
Is there an online source I can use to figure out which of my medications might interact with CBD?
Online databases are available to help health professionals evaluate potential drug-drug interactions, at a price. “Freely available resources tend to be less reliable, and this highlights the importance of discussing all your medications, including CBD, with your doctor and pharmacist,” says Dr. Bemben.
One source available to patients is drugs.com, where you can plug in either cannabidiol (which will give you the FDA-approved oral product Epidiolex) or cannabis (which will give you both THC and CBD) and check for possible interactions with other medications you take.
Has anyone had a life-threatening drug interaction with CBD?
“There haven’t been reports of serious drug-drug interactions with over-the-counter CBD products. However, these products are relatively new and it typically takes time for reports to be published. We have very little information about over-the-counter CBD products and how they may interact with other drugs,” says Dr. Bemben.
Learn more about CBD interactions with drugs and how to stay safe when you use CBD for pain or other symptoms.