404 G.A. Cabral and A. Staab
Difranco et al. (1996), through the San Francisco Men’s Health Study (SFMHS),
evaluated in a 6-year follow-up study the association of specific recreational drugs
and alcohol with laboratory predictors of AIDS. No association with progression to
AIDS was observed for marijuana use. Wallace et al. (1998) examined risk factors
and outcomes associated with identification ofAspergillus in respiratory speci-
mens from individuals with HIV disease as part of a study to evaluate pulmonary
complications of HIV infection. Cigarette and marijuana use was found not to be
associated withAspergillusrespiratory infection. Persaud et al. (1999) conducted
a cross-sectional survey among 124 street- and brothel-based female commercial
sex workers in Georgetown, Guyana, to determine the seroprevalence of HIV in-
fection and describe the sexual practices and drug use patterns. No statistically
significant association was found between HIV infection and marijuana use. Miller
and Goodridge (2000) evaluated in a retrospective study the relationship between
marijuana use and sexually transmitted diseases in pregnant women. The preva-
lence of gonorrhea, Chlamydia, syphilis, HIV, hepatitis B surface antigen, human
papilloma virus, and HSV was determined. No significant differences were found
in the prevalence of any single—or more than one—sexually transmitted disease
between pregnant women who used marijuana and drug-free pregnant women.
Bredt et al. (2002) examined the short-term effects of cannabinoids on immune
phenotype and function in HIV-1-infected patients. A randomized, prospective,
controlled trial comparing the use of marijuana cigarettes (3.95% THC), dronabi-
nol (2.5 mg), and oral placebo in HIV-infected adults taking protease inhibitor-
containing highly active antiretroviral therapy (HAART) was undertaken. Few
statistically significant effects on immune system phenotypes or functions were
found in this patient population. Struwe et al. (1993) studied the effect of dronabi-
nol (THC) on nutritional status in HIV infection and found that, in a selected group
of HIV-infected patients with weight loss, short-term treatment with dronabinol
resulted in improvement in nutritional status and symptom distress. Recently,
Abrams et al. (2003) conducted a randomized, placebo-controlled 21-day clinical
trial to examine the short-term effects of smoked marijuana on the viral load in
67 HIV-infected patients. The study was conducted in an inpatient setting at the
General Clinical Research Center at the San Francisco General Hospital, San Fran-
cisco, California. Participants were randomly assigned to a 3.95%-THC marijuana
cigarette, a 2.5 mg dronabinol (THC) capsule, or a placebo capsule three times
daily before meals. It was concluded that smoked and oral cannabinoids did not
appear to present a risk in individuals with HIV infection with respect to HIV RNA
levels, CD4+and CD8+cell counts, or protease inhibitor levels.
On the other hand, there are reports that marijuana use is associated with
compromised health status among HIV-infected individuals. Lozada et al. (1983)
assessed oral manifestations of tumor and opportunistic infections in 53 AIDS-
affected men with Kaposi’s sarcoma (KS). Twenty-seven had biopsy-proved oral
KS, the palate being the most common site. Past or present infections with cy-
tomegalovirus, hepatitis, venereal diseases, and gastrointestinal microorganisms
occurred in more than 70%. Oral candidiasis was confirmed in 57%. Heavy
marijuana smoking was identified as the most common habit among these in-
dividuals. Newell et al. (1985) reported that marijuana use was a risk factor