THE EFFECTIVENESS OF CANNABINOIDS FOR THE TREATMENT OF CACHEXIA IN HIV-POSITIVE PATIENTS

Knowledge of the role of the endocannabinoid system in the modulation of immune functions, the influence of mood, the regulation of appetite, gives us the right to think about the possibility of use of cannabinoids for the treatment of cachexia. Cachexia, also known as weight loss syndrome, is a common problem in patients with human immunodeficiency virus (HIV). Weight loss syndrome is defined as a loss of at least 10% of the body weight. In HIV-positive patients, weight loss syndrome has been associated with chronic diarrhea, fatigue, and fever for at least 30 days. This serious situation leads to significant morbidity and mortality for these patients. The use of cannabinoids to improve appetite and regain weight in HIV-positive patients is recommended, but it is unclear whether they are truly safe and effective. MARINOL (dronabinol), 2.5, 5 or 10 mg tablets is the only synthetic cannabinoid (tetrahydrocannabinol (THC) isomer) intended for oral administration and FDA approved for two indications: treatment of anorexia associated with weight loss in people with acquired immune deficiency syndrome (or HIV-positive patients) and vomiting caused by chemotherapy in people whose nausea and vomiting have not improved with usual antiemetics. In the United States, Marinol is treated as a non narcotic drug with a very low risk of physical and mental dependence (categorized into level III of controlled substances). The dosage for treatment of weight loss depends on tolerability, from 1 x 2.5 mg /day to 2 x 10 mg /day. The medicine is stated to be taken before meals: before dinner when is administered once daily or before breakfast and dinner if the total dose is divided into twice daily intake. An online literature review published by June 2018 identified a total of six randomized clinical trials (RCTs) that were conducted to evaluate the effects of dronabinol for the treatment of cachexia in HIV-positive patients. They included a total of 298 patients. In 5 of the six studies conducted, the effects of dronabinol were compared with placebo, and in only one study the effects of dronabinol were compared with megestrol acetate. Only one of the six studies was classic placebo-controlled study that reported the effects of dronabinol on body weight correction, while in other studies the effects of dronabinol on body weight correction were secondary notification. This study is also the only study on which base indication for dronabinol are approved. Studies show that dronabinol at doses of 5mg /day stimulates weight gain compared with placebo. Dronabinol compared to megestrol showed a lack of effect. The conclusion of these studies, however, is that use of cannabinoids can have a positive effect on improving appetite and weight gain in HIV-positive patients.