Can medical marijuana help HIV patients suffering from chronic inflammation and related neurological disorders? That’s a question a San Antonio scientist is looking to answer over the next five years.

Mahesh Mohan received a $3.5 million grant from the National Institutes of Health. He will use this funding to lead a study using laboratory primates to measure marijuana’s efficacy as a treatment for individuals who suffer from HIV-associated neurocognitive disorder, or HAND.

Conducted at San Antonio’s Texas Biomedical Research Institute, Mohan’s research will evaluate what effects the psychoactive component of marijuana – the mind-altering aspect, tetrahydrocannabinol (THC) –  and its non-psychoactive counterpart cannabidiol (CBD) have on patients with HAND. 

Coined in the 1980s, HAND is a form of dementia caused by HIV, the virus that causes AIDS. Prior to modern-day HIV medications such as antiretroviral therapy, HAND caused many HIV patients to later develop difficulties with their concentration, memory, organizational skills, and decision-making. 

While HIV patients today can utilize retroviral drug therapies to reduce complications from HIV and better their chances of survival, there still exists modern cases of HAND – even in patients on drug therapy, Mohan said. According to a statement by Texas Biomed, HAND is a condition that still affects 50 percent of HIV-infected patients who are on antiretroviral therapy.

“Now we have good antiretroviral drugs that can suppress the virus, but it doesn’t eradicate the virus. The virus continues to persist,” Mohan told the San Antonio Report. “Because of its persistence, many of these patients have chronic inflammation. … One of the priorities of HIV researchers … is to reduce this chronic inflammation.”

Cannabinoids have previously shown great promise for the treatment of neurological disorders, Mohan said. That’s why he and his team wanted to see if cannabinoids could have therapeutic effects in HIV patients suffering from HAND.

A pharmacologist who has studied drug abuse, cannabinoids, and medicinal interactions, UT Health San Antonio’s Dr. Brett Ginsburg said results for medical marijuana use in multiple illnesses have shown to be promising.

“There’s over 400 different chemicals that we call cannabinoids in the [cannabis] plant,” Ginsburg said. “There seems to be some evidence … they may have immune-modulating or immune-affecting effects that may decrease the development or progression of … cognitive decline. I think that’s what people are interested in: Are those immune-modulating effects?”

Despite promising results in scientific studies, medical marijuana is not yet fully legalized in Texas, although lawmakers appear to be moving toward eventual full approval. Under the Texas Compassionate Use Program, low-THC medical marijuana can be prescribed in Texas only to Texans who have specific types of epilepsy, terminal cancer, or specific neurodegenerative diseases.

Multiple bills supporting legalization have been introduced in past legislative sessions, and a new wave of proposed legislation is expected to be introduced in the 2021 session that opens in January.

It’s a meaningful issue for state Sen. José Menéndez (D-San Antonio). Menéndez said he first became aware of the beneficial effects of medical marijuana when his father-in-law was diagnosed with cancer eight years ago. Since then, Menéndez has filed bills the past three state legislative sessions in favor of expanding the number of medical conditions that qualify for use of medical marijuana under the Compassionate Use Program.

During the pre-filing stage for the 2021 legislative session, Menéndez filed Senate Bill 90, another attempt at expanding the uses of medical marijuana.

“If we really respect [Texans], we should let the medical professionals and the adult patients make the decisions about what’s the best thing for their medical treatment,” Menéndez said. “I don’t understand why we as politicians and state elected officials think that we should be deciding who the winners and losers are in terms of people who want to use cannabis-based therapies.”

Menéndez, whose wife has multiple sclerosis, said many doctors he’s spoken with say marijuana is highly effective at treating nerve pain without the negative side effects other drugs have. Multiple sclerosis is a neurological disease that can affect the brain, spinal cord, and optic nerves. There is evidence medical cannabis can help relieve symptoms of multiple sclerosis.

With 36 states and four territories having approved cannabis for full, regulated medical use – including Texas’ border states of Louisiana, Oklahoma, New Mexico, and Arkansas – Texas is behind in the game, Menéndez said.

As the director of Texans for Responsible Marijuana Policy, Heather Fazio said she agrees with Menéndez that legalizing cannabis for medical uses shouldn’t be a partisan political issue.

“It really is essential when it comes to medical use – it’s about people and families and medicine,” Fazio said. “One of our priorities is making the Compassionate Use Program more inclusive.”

Fazio said she’s spoken with dozens of veterans, cancer patients, and others with illnesses who have called marijuana their “exit drug,” because it helped them get off opioids or other painkillers with strong side effects.

Should Texas take the path of regulation and legalization, it could be bringing in another billion dollars in tax revenue per budget cycle, which is every two years, Fazio said.

Over the next five years, Mohan and his collaborators at Texas Biomed will see how THC and CBD, alone or in combination, can affect levels of inflammation in the brain through studying the drug compounds’ effects on Indian rhesus macaques with Simian immunodeficiency virus (SIV), the non-human primate equivalent of HIV.

These studies will use advanced scientific practices, PET and CT scans, and newly developed techniques to evaluate the impact of cannabinoids on neuroinflammation, Texas Biomed said.

Believing neuroinflammation is a major cause of HAND, Mohan said he and his collaborators believe they will have “some very interesting findings.”

“Our study will add a more mechanistic understanding for researchers regarding the factors behind HAND and potentially lead to the development of more cannabinoid-based therapies,” Mohan said. “Finding the best therapeutic approach whether it is a single drug, a combination cannabinoid regimen, or a synthetic cannabinoid drug is important.” 

Lindsey Carnett

Lindsey Carnett

Lindsey Carnett is the general assignment reporter for the San Antonio Report.