High-intensity cannabis use and HIV clinical outcomes among HIV-positive people who use illicit drugs in Vancouver, Canada

Abstract

Background Reforms to the legal status of medical and non-medical cannabis are underway in many jurisdictions, including Canada, as are renewed efforts to scale-up HIV treatment-as-prevention (TasP) initiatives. It has been suggested that high-intensity cannabis use may be associated with sub-optimal HIV treatment outcomes. Thus, using data from a setting with a community-wide treatment-as-prevention (TasP) initiative coinciding with increasing access to medical cannabis, we sought to investigate the possible impact of high-intensity cannabis use on HIV clinical outcomes. Methods Data was derived from the ACCESS study, a prospective cohort of HIV-positive people who use illicit drugs (PWUD) in Vancouver, Canada. Cohort data was confidentially linked to comprehensive clinical profiles, including records of all antiretroviral therapy (ART) dispensations and longitudinal plasma HIV-1 RNA viral load (VL) monitoring. We used generalized estimating equations (GEEs) to estimate the longitudinal bivariable and multivariable relationships between at least daily cannabis use and two key clinical outcomes: overall engagement in ART care, and achieving a non-detectable VL among ART-exposed participants. Results Between December 2005 and June 2015, 874 HIV-positive PWUD (304 [35%] non-male) were included in this study. In total, 788 (90%) were engaged in HIV care at least once over the study period, of whom 670 (85%) achieved non-detectable VL at least once. In multivariable analyses, ≥ daily cannabis use did not predict lower odds of ART care (Adjusted Odds Ratio [AOR]: 1.02, 95% confidence interval [CI]: 0.77–1.36) or VL non-detectability among ART-exposed (AOR: 0.96, 95% CI: 0.75–1.21). Conclusion Our results showed no statistically significant impact of daily cannabis use on the likelihood of ART care or VL non-detectability among ART-exposed HIV-positive PWUD. These findings are reassuring in light of the impending legalization of cannabis in Canada and ongoing efforts to expand TasP initiatives.

High‐intensity cannabis use is associated with retention in opioid agonist treatment: a longitudinal analysis

“…In light of recent findings from this research group on the cannabis decriminalization and outcomes from HIV treatment , as well as possible links between cannabis use and the use of other substances , we developed the current study to estimate the effect of cannabis use on engagement in OAT. The study hypothesis and analytical approach were developed by two authors (E.S.…”

“…Given the urgent need to identify novel effective strategies to address the ongoing opioid crisis in North America, and in the context of the increasing availability of cannabis (through both medical and adult‐use laws), it is critical to understand more clearly the impacts of cannabis use on OAT outcomes—including its potential therapeutic potential. Therefore, the aim of the present study was, first, to estimate the relationship between at least daily cannabis use and retention in treatment among people initiating OAT in Vancouver, Canada, a setting with de facto decriminalization of cannabis use . As a secondary aim we tested the impacts of less frequent cannabis use.…”

HealthCall delivered via smartphone to reduce co-occurring drug and alcohol use in HIV-infected adults: A randomized pilot trial

“…However, substantial disparities remain (Hall et al, 2013) since African-Americans and Hispanics are at greater risk for HIV infection (Giordano et al, 2010; Harrison, Song, & Zhang, 2010; Siddiqi et al, 2015), and for failure to achieve viral suppression once infected (Castel et al, 2016; Xia, Sun, Wiewel, & Torian, 2017). HIV-infected individuals with alcohol and drug problems are also more likely than others to have poor health behaviors (Crane et al, 2017; Metrik, Caswell, Magill, Monti, & Kahler, 2016; Young, Wood, Dong, Kerr, & Hayashi, 2015), lower engagement in and utilization of HIV care, and lower ART adherence (Gwadz et al, 2016; Lake et al, 2017; Lucas, 2011). Further, the dual use of illicit drugs and alcohol, more than the use of either one alone, is associated with poor quality of HIV care (Dickson-Gomez, Bodnar, Petroll, Johnson, & Glasman, 2015; Korthuis et al, 2012), viral resistance to treatment, and HIV disease progression (Azar et al, 2015; Baum et al, 2009; Lima et al, 2014).…”

Effect of Cannabis Use on Human Immunodeficiency Virus DNA During Suppressive Antiretroviral Therapy

“…Cannabis is widely consumed in the United States [1], particularly among people living with human immunodeficiency virus (HIV) [2][3][4], and this has fostered an important debate regarding the impact of cannabis on virologic and inflammatory biomarkers. On one hand, a recent study reported reduced adherence to antiretroviral therapy (ART) and retention in care in cannabis users [5], and 2 other studies found no effects of cannabis on viral suppression [4,6]. On the other hand, 1 study has demonstrated beneficial impacts of cannabis on plasma HIV RNA among recently infected people living with HIV (PLWH) [7].…”