The impact of medical cannabis on pain and inflammation in people living with HIV

摘要 Deepka Slawek博士的总体目标是改善艾滋病毒携带者(PLWH)的健康结果，重点是 关于确定医用大麻的影响。PLWH有很高的痛苦负担，最常见的是 体验神经性疼痛。它与严重的残疾有关，包括功能障碍、贫乏 抗逆转录病毒粘附性和病毒学失败。PLWH的神经病理性疼痛与持续性全身疼痛有关 尽管病毒学受到抑制，但炎症与心理症状密切相关。它是 经常使用阿片类药物管理，尽管滥用和使用障碍的风险很高，促使人们对 治疗疼痛的替代疗法，如医用大麻。医用大麻的使用正在爆炸性地增加 在美国，疼痛和艾滋病毒是大多数州的合格条件。虽然医用大麻 在迄今为止完成的为数不多的随机对照试验中，成功地减少了疼痛，但我们的 了解医用大麻如何影响PLWH的神经病理性疼痛。目前还没有研究评估这种 医用大麻的主要活性成分--9-四氢大麻酚(THC)和大麻二酚(CBD)的影响 PLWH中的神经病理性疼痛；没有一种产品能与医疗配药相媲美 大麻药房；没有人研究医用大麻对炎症的影响；也没有人研究过 研究了医用大麻如何影响不良事件(例如，心理症状、抗逆转录病毒药物 粘附性和病毒学故障)。联邦政策要求对医用大麻进行随机试验 PLWH中慢性疼痛的治疗是不可行的。因此，这项研究将使用两种优惠券 为在纽约合法分发的医用大麻产品提供大幅折扣。这个K23 以病人为导向的导师职业发展奖将培训Slawek医生获得成功所必需的技能 在艾滋病毒和大麻研究领域。这些是：1)随机试验的设计和实施，2) 翻译大麻研究，3)因果推理，4)中介分析。这些技能将应用于 一项创新研究，旨在测试为高THC医用大麻产品提供大幅折扣的优惠券如何 或高CBD医用大麻产品会影响PLWH中的神经病理性疼痛、炎症和不良事件。 通过一个多学科的指导团队、正式的课程安排和拟议的研究项目，Dr。 Slawek将实现成为一名独立调查员所需的专业成长 这些发现将是公共卫生部门护理工作不可或缺的一部分。

ABSTRACT Dr. Deepika Slawek’s overall goal is to improve health outcomes in people living with HIV (PLWH), with a focus on determining the impact of medical cannabis. PLWH have a high burden of pain, and most commonly experience neuropathic pain. It is associated with significant disability, including functional impairment, poor antiretroviral adherence, and virologic failure. Neuropathic pain in PLWH is related to persistent systemic inflammation despite virologic suppression and is deeply interrelated with psychological symptoms. It is frequently managed with opioids, despite a high risk of misuse and use disorder, prompting interest in alternative therapies for pain like medical cannabis. Medical cannabis use is explosively increasing in the United States, and pain and HIV are qualifying conditions in most states. Though medical cannabis successfully reduced pain in the few randomized control trials completed to date, there remain gaps in our understanding of how medical cannabis affects neuropathic pain in PLWH. No studies have evaluated how the main active components of medical cannabis, ?9-tetrahydrocannabinol (THC) and cannabidiol (CBD) impact neuropathic pain in PLWH; none have occurred with products comparable to those dispensed at medical cannabis dispensaries; none have examined the impact medical cannabis has on inflammation; and none have studied how medical cannabis impacts adverse events (e.g., psychological symptoms, antiretroviral adherence, and virologic failure). Federal policies make conducting a randomized trial of medical cannabis for the management of chronic pain in PLWH infeasible. Therefore, this study will employ two coupons that provide deep discounts to medical cannabis products that are legally dispensed in New York. This K23 mentored patient-oriented career development award will train Dr. Slawek in skills necessary to be successful in the fields of HIV and cannabis research. These are: 1) design and conduct of randomized trials, 2) translational cannabis research, 3) causal inference, and 4) mediation analysis. These skills will be applied to an innovative study to test how coupons that provide deep discounts for high THC medical cannabis products or high CBD medical cannabis products affect neuropathic pain, inflammation, and adverse events in PLWH. Through a multidisciplinary mentorship team, formal coursework, and the proposed research project, Dr. Slawek will achieve the professional growth needed to become an independent investigator contributing critical findings that will be integral to the care of PLWH.