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

摘要 博士Deepika Slawek的总体目标是改善艾滋病毒感染者（PLWH）的健康状况， 确定医用大麻的影响。PLWH有很高的疼痛负担，最常见的是 经历神经性疼痛。它与严重残疾相关，包括功能障碍、不良 抗逆转录病毒依从性和病毒学失败。PLWH中的神经病理性疼痛与持续的全身性疼痛有关。 尽管病毒学抑制，但炎症仍然存在，并且与心理症状密切相关。是 尽管滥用和使用障碍的风险很高，但经常使用阿片类药物进行管理， 比如医用大麻医用大麻的使用在美国呈爆炸性增长， 疼痛和艾滋病毒是大多数州的合格条件。虽然医用大麻 在迄今为止完成的少数随机对照试验中，成功地减轻了疼痛，但我们的研究仍存在差距。 了解医用大麻如何影响PLWH的神经性疼痛。没有研究评估了 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中的神经性疼痛;使用与医疗中心分发的产品相当的产品时未发生神经性疼痛 大麻药房;没有人检查过医用大麻对炎症的影响;也没有人 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 粘附和病毒学失败）。联邦政策规定对医用大麻进行随机试验， PLWH患者的慢性疼痛管理不可行。因此，本研究将采用两个试样， 为在纽约合法分发的医用大麻产品提供大幅折扣。K23 一个指导性的以病人为导向的职业发展奖将培训斯拉韦克博士成功所需的技能 在艾滋病和大麻研究领域。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，和4）调解分析。这些技能将应用于 一项创新的研究，以测试优惠券如何为高THC医用大麻产品提供大幅折扣 或高CBD医用大麻产品影响PLWH的神经性疼痛，炎症和不良事件。 通过一个多学科的导师团队，正式的课程，和拟议的研究项目，博士。 Slawek将实现成为一名独立调查员所需的专业成长，做出关键贡献 这将是对艾滋病毒携带者护理不可或缺的结果。

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.