Previously it was shown that short-term marijuana use did not influence nelfinavir metabolism. Although marijuana use did produce a drop in indinavir levels, this fall was small and unlikely to be clinically meaningful (see Reuters Health story March 20, 2002). However, it still remained unclear whether cannabinoid use had an effect on viral load or CD+ cell counts.

To investigate, Dr. Donald I. Abrams, from the University of California at San Francisco, and colleagues assessed the outcomes of 67 HIV-infected patients who were randomly assigned to use marijuana cigarettes, cannabinoid capsules, or sugar pills (placebo) three times daily for 21 days. All of the patients had been receiving the same antiretroviral regimen, which included indinavir or nelfinavir, for at least 8 weeks before the study began.

More than half of the subjects in each group had undetectable viral loads throughout the study, the researchers note. Although not statistically significant, marijuana and cannabinoid use were actually associated with a slight drop in viral load compared with placebo use.

Marijuana and cannabinoid use did not produce a drop in CD4+ or CD8+ cell counts. In fact, compared with placebo use, treatment with these agents was actually associated with a slight increase in cell counts.

The results suggest that short-term cannabinoid use is not unsafe for patients with HIV infection, the authors note. "Further studies investigating the therapeutic potential of marijuana and other cannabinoids in patients with HIV infection and other populations are ongoing and should provide additional safety information over longer exposure periods," they write.

SOURCE: Annals of Internal Medicine, August 9, 2003.

NEW YORK (Reuters Health) - HIV-infected patients who have another virus in their blood, called human herpesvirus 8 (HHV-8), are at risk for developing Kaposi's sarcoma (KS), a skin cancer seen in HIV-infected patients but rare in other people.

To identify risk factors for KS, Dr. Eric A. Engels, from the National Cancer Institute in Rockville, Maryland, and colleagues studied 132 HIV-infected men. Blood samples were taken on a yearly basis and the men were followed for several years. During the study, 31 men were diagnosed with KS.

The new findings are reported in the medical journal AIDS.

Men who had HHV-8 in their blood were nearly twelve times more likely to develop KS than men who didn't. Given this finding, men with HHV-8 should possibly be treated with antiviral drugs in an attempt to prevent KS, the authors note.

In a related report, Dr. Nicole H. T. M. Dukers, from the Municipal Health Service in Amsterdam, and Dr. Giovanni Rezza, from the Istituto Superiore de Sanita in Rome, reviewed previous studies that have looked into the spread of HHV-8.

Spread of HHV-8 by blood is probably rare in countries in which the virus is not endemic, Dukers and Rezza note. "However, blood-borne transmission is a possibility that must be considered in high endemic countries."

SOURCE: AIDS, August 15, 2003.

By Megan Rauscher

NEW YORK (Reuters Health) - Antioxidant supplements taken by people with HIV appear to improve cholesterol levels and midriff weight gain, but may have a negative impact on blood sugar levels.

Those findings come from a small pilot study of 10 patients who had the HIV-related fat-redistribution syndrome known as lipodystrophy, or continuously high blood levels of lactic acid. All were on stable treatment with standard antiretroviral drugs.

The two women and eight men were given supplements of vitamin E (800 IU per day), vitamin C (1000 milligrams daily), and N-acetylcysteine (NAC) (600 milligrams twice daily). Dr. Grace McComsey and a team at Case Western Reserve University in Cleveland, Ohio, report the results in the Journal of Acquired Immune Deficiency Syndromes.

After 24 weeks, body measurements showed no significant change in circumferences or skinfold thickness, except for a "modest" decrease in waist-to-hip ratio. Triglycerides and total and HDL ("good") cholesterol did not change markedly, but there was a trend toward lower LDL ("bad") levels.

"Even with the small study sample size, we were able to show some improvement of LDL cholesterol and waist-to-hip ratio, both being very promising findings," Dr. McComsey told Reuters Health.

However, the patients' metabolism showed worsening resistance to insulin during the study, and fasting glucose levels increased significantly.

This is "very concerning," McComsey told Reuters Health, "and reminds us that we should always investigate vitamins/herbals supplements prior to their use in HIV-infected subjects. We should never assume that high doses of vitamins are safe. They are not safe until clinical studies prove them to be safe."

SOURCE: Journal of Acquired Immune Deficiency Syndromes, August 15, 2003.

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