Paper On HIV/Aids and How It Causes Neuropathy
By
Medicine and Health
Tutor
April 29, 2020
According to Healthline, HIV is a virus that damages the immune system. When a person is infected with HIV, and it is not treated, the CD4 cells in the body are affected significantly, and this makes the body susceptible to various infections. The HIV virus is transmitted through bodily fluids, which include blood, breast milk, semen, vaginal and rectal fluids. People with the HIV virus develop AIDS, especially when the immune system of the body is damaged extensively. HIV progresses through 3 stages, which are stage 1, which is the acute stage just a few weeks after transmission, chronic stage, and finally, AIDS. Persons with HIV are considered to have progressed to AIDS if the CD4 cells in the body are below 200 cells per cubic millimeter of blood and develop opportunistic infections regardless of the CD4 count. The symptoms of AIDS include loss of weight, fever, fatigue, recurrent infections, and so on. It is important to note that there is no cure for the disease, but adherence to antiretroviral regimens can significantly reduce the progress of the disease.
When one or more nerves are damaged, numbness, tingling, weakness in muscles, and pain in affected areas is realized. This is referred to as NeuropathyNeuropathy. Usually, the hands and feet are the areas that start to be affected, but other body parts can be affected as well. Neuropathy can be treated through the use of antidepressants, which include pain medication, anti-seizure medication, and pain-relieving creams. Notably, peripheral NeuropathyNeuropathy can result from hereditary disorders, inflammatory infections, auto-immune diseases, among others. In relation to HIV/AIDS, NeuropathyNeuropathy is common in people with advanced HIV. The common symptoms that patients experience include stiffness, numbness, loss of feeling in toes, and soles of the feet and burning. In some instances, nerves in hands, wrists, or fingers are affected as well. According to Schutz and Robinson, Distal symmetric polyneuropathy (DSP) affects about 50% of individuals infected with HIV; thus, the most common neurological complication. There are two pathophysiologic processes that are believed to significantly contribute to the development of HIV DSP, notably direct neurotoxicity of the HIV virus and the neurotoxicity of the cART medications.
There are numerous studies that have been conducted to establish the effectiveness of Cannabis in the management of HIV neuropathy. Notably, it has been established that the presence of cannabinoid receptors in the central and peripheral nervous system modulate pain perception. According to Ellis et al., a randomized clinical trial was conducted on smoked Cannabis for neuropathic pain in HIV. The study investigated the impact of smoked Cannabis in the management of neuropathic pain in patients with HIV. It was established that patients exhibited pain relief to a greater extent compared to those that were under placebo treatments. Furthermore, the daily functioning of patients improved during the treatment period. This is in agreement with another study conducted by Abrams et al., where the investigators sought to establish the effectiveness of Cannabis in sensory NeuropathyNeuropathy. The study concluded that in HIV-associated sensory NeuropathyNeuropathy, smoked Cannabis did effectively relieve chronic neuropathic pain.
Woolbridge et al. investigated the use of Cannabis in HIV patients for pain. In the study, it was found out that about 94% of the participants reported improved muscle pain. Notably, it was reported that a large number of patients reported that Cannabis improved system control. In an article by Moore, Cannabis has been deemed to be a neurogenerative, neuroprotector, and an analgesic. Notably, it was noted that NF-kb production is inhibited by Cannabis in addition to cytokines, and as a result, inflammation and nociceptive pain is decreased. Furthermore, through Cannabis, the myelin sheath covering the nerve is protected. Notably, research has also shown that Cannabis also acts as a neuroprotective agent. The cannabidiol or Tetrahydrocannabidiol do bind to specific cannabinoid receptors in the brain, and the peripheral nervous system through chronic pain is alleviated (Foundation for peripheral NeuropathyNeuropathy). However, there are risks associated with the use of Cannabis, and these include impairment in attention and memory with acute use, psychiatric effects, for example, the development of social anxiety disorders (McMaster University).
Notably, treatment of HIV neuropathic is largely dependent on the type. If the cause of NeuropathyNeuropathy is a result of antiretroviral toxicity, it is prudent to stop the use of the offending drug. Notably, neuropathic pain can be treated through the use of anti-seizure medications, antidepressant analgesics or opioids. Notably, antidepressants are considered as the first line of drugs for pain management in patients with NeuropathyNeuropathy. However, their use in patients with HIV frequently results in drug interaction, thereby affecting the effectiveness of both the antiretroviral drugs and the antidepressants. The use of opioids has been found to be beneficial in the treatment of HIV-associated neuropathies. There are unique opioids that offer superior efficacy, and they include methadone, levorphanol, tapentadol, and tramadol (Practical Pain Management, 2020).
Opioids can temporarily relieve the symptoms of moderate to severe HIV related pain. It is recommended that a short course of opioids be used for treating acute worsening of pain. Notably, opioids are not recommended for chronic pain. Notably, most healthcare providers are moving away from the use of opioids due to their high potential for addiction and misuse (Liu et al.). Furthermore, they are associated with adverse reactions. The effect of opioids is realized following their action in the brain, brainstem, spinal cord, or in some situations, the peripheral terminals of primary afferent neurons (Fornasari). Strong doses of opioids are considered to be efficacious in comparison to other drugs for neuropathic pain. However, despite their efficacy, long term use has raised a number of issues. These include aspects of tolerability, the possibility of developing tolerance to the analgesic effect, and the risk of addiction. In a research project by Sabita et al., it was indicated that repeated use of opioid analgesics promotes neuropathic pain in HIV patients.
Consequently, following the adverse impact associated with the use of opioids for treating HIV related NeuropathyNeuropathy, it is prudent that the use of Cannabis is considered. It has been established via clinical data that repeated use of opiate medication can significantly heighten chronic pain states in patients with HIV. Notably, opioids can worsen the damaging effects of HIV-1 infection on the nervous system. Numerous studies have indicated that Cannabis can effectively relieve sensory NeuropathyNeuropathy. However, it’s is use is also associated with adverse effects. For example, the THC acts on specific brain receptor cells which are primary for brain development and functionality. When used for other purposes besides medication, THC overexcites the brain cell. Notably, its use in young people can dramatically affect cognitive function over the long term. Despite the benefits of using Cannabis, there is limited data regarding long term safety on treatment using Cannabis. Therefore, more studies are required to establish a risk-benefits profile. Meanwhile, it is prudent that doctors recommend Cannabis for peripheral NeuropathyNeuropathy after careful consideration.
References
Abrams, Donald I., et al. “Cannabis in painful HIV-associated sensory neuropathy: a randomized placebo-controlled trial.” Neurology 68.7 (2007): 515-521.
Ellis, Ronald J., et al. “Smoked medicinal cannabis for neuropathic pain in HIV: a randomized, crossover clinical trial.” Neuropsychopharmacology 34.3 (2009): 672-680.
Fornasari, Diego. “Pharmacotherapy for neuropathic pain: a review.” Pain and Therapy, 6.1 (2017): 25-33.
Foundation for peripheral NeuropathyNeuropathy. “Medical Marijuana For Peripheral Neuropathy | The Foundation For Peripheral Neuropathy.” Foundationforpn.Org, 2020, https://www.foundationforpn.org/2019/05/14/medical-marijuana-for-peripheral-neuropathy/. Accessed April 29, 2020.
HIV and AIDS: Causes, Symptoms, Treatments, and More. (2020). Retrieved April 29, 2020, from https://www.healthline.com/health/hiv-aids/
Liu, Bolong, Xin Liu, and Shao-Jun Tang. “Interactions of opioids and HIV infection in the pathogenesis of chronic pain.” Frontiers in Microbiology 7 (2016): 103.
Moore, Melisa. “Using Cannabis As A Treatment For Neuropathy | Cannabis Sciences.” Labroots, 2018, https://www.labroots.com/trending/cannabis-sciences/11854/using-cannabis-treatment-neuropathy.
McMaster University. “Cannabis For Chronic Nerve Pain: A Half-Baked Solution?”. McMaster University, 2020, https://www.mcmasteroptimalaging.org/blog/detail/blog/2018/08/07/cannabis-for-chronic-nerve-pain-a-half-baked-solution.
Schütz, S. G., & Robinson-Papp, J. (2013). HIV-related NeuropathyNeuropathy: current perspectives. HIV/AIDS (Auckland, NZ), 5, 243.
“Neuropathy In HIV Patients: Pain Concerns.” Practical Pain Management, 2020, https://www.practicalpainmanagement.com/pain/neuropathic/hiv-neuropathy/neuropathy-hiv-patients-pain-management-concerns.
Sabita, Roy et al. “Role Of Gut Microbiome In HIV/Opioid-Induced Peripheral Neuropathy.” University Of Miami’s Research Profiles, 2018, https://miami.pure.elsevier.com/en/projects/role-of-gut-microbiome-in-hivopioid-induced-peripheral-neuropathy. Accessed April 29, 2020.
Woolridge, Emily, et al. “Cannabis use in HIV for pain and other medical symptoms.” Journal of Pain and symptom management 29.4 (2005): 358-367.