Marijuana use and viral suppression in persons receiving medical care for HIV-infection

Abstract

Background Marijuana use is common among persons living with HIV (PLWH), but its effect on HIV clinical outcomes has not been thoroughly studied. Objectives We determined the association between marijuana use and HIV viral suppression among PLWH. Methods Data came from five repeated cross-sections (2009 – 2013) of the Florida Medical Monitoring Project, a population-based sample of PLWH in Florida. Data were obtained via interview and medical record abstraction. Weighted logistic regression models were used to determine the association between marijuana use (past 12-months) and durable viral suppression (HIV-1 RNA value of ≤ 200 copies/milliliter in all measurements within the past 12-months). Results Of the 1,902 PLWH receiving antiretroviral therapy and completed an interview and had a linked medical record abstraction, 20% reported marijuana use in the past 12 months (13% less than daily and 7% daily use). Of the total sample, 73% achieved durable viral suppression. In multivariable analysis, marijuana use was not significantly associated with durable viral suppression in daily [Adjusted Odds Ratio (AOR):0.87, 95% confidence interval (CI): 0.58, 1.33] or in less than daily [AOR: 0.83, 95% CI: 0.51, 1.37] users as compared to non-users when adjusting for sociodemographic factors, time since HIV diagnosis, depressive symptoms, alcohol, cigarette and other substance use. Conclusion In this sample of PLWH receiving medical care in Florida, there was no statistically significant association between marijuana use and viral suppression. As our findings suggest the possibility of a clinical important effect, there is a need for additional evidence from other samples and settings that include more marijuana users.

Marijuana use and HIV treatment outcomes among PWH receiving care at an urban HIV clinic

“…Consistent with our results, a recent longitudinal cohort study of illicit drug users with HIV in Vancouver found no association between daily marijuana use and treatment adherence in multivariable analysis [16]. Similarly, in a recent analysis of a Florida cohort of PWH, no relationship between marijuana use and HIV outcomes was observed [10]. It is important to emphasize that, like the other two, very recent negative studies, our sample includes individuals in care at a time with simpler, less toxic ART regimens which may in part account for their good treatment outcomes.…”

“…A multicenter cohort of HIV infected patients receiving care in 8 US cities between 2013–2015 found 31.6% of patients reported marijuana use during the past 3 months [9]. In a recent Florida sample of PWH in care, 20% reported recent marijuana use with 7% reporting daily use [10]. With these elevated levels of marijuana use among PWH receiving care, there is need to better characterize the relationship between marijuana use and HIV treatment outcomes, controlling for the frequent comorbidity with alcohol and other illicit drug use.…”

“…In one study cannabis dependent patients were more likely to have significantly lower recent adherence and higher viral load than nondependent users or non-users, although these effects were mitigated by age, education and alcohol consumption [15]. Others have found no significant association between marijuana use and viral suppression [4, 10]. The inconsistency of findings across studies highlights the need for further evaluation of these relationships in larger, mixed sex samples.…”

Prevalence and correlates of marijuana use among HIV-seropositive and seronegative men in the Multicenter AIDS Cohort Study (MACS), 1984–2013

“…These findings are similar to prior studies that report no significant or clinically meaningful differences in HIV viral load (44,45) or CD4+ cell count among marijuana users (46–48) as compared to non-users. Yet others have found significantly lower HIV viral load (49,50) and higher CD4+ count (49) in marijuana users, although these studies differ methodologically as well as in the samples included.…”

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

“…The first cross-sectional study examined VL among individuals who met DSM-IV criteria for cannabis dependence versus non-dependent cannabis users and non-users, and found that dependent users (who reported slightly more than daily use, on average) were significantly more likely to have a detectable VL, compared with the non-dependent users (who reported < daily use, on average), or the non-users (Bonn-Miller et al, 2014). Contrastingly, and more in line with the presently recorded findings, in the second cross-sectional study, which was conducted among a representative sample of patients on HIV treatment in the state of Florida, daily cannabis use was not significantly associated with viral suppression (Okafor et al, 2016). In the RCT, no significant differences were found in short-term change in mean VL between participants randomized to smoke cannabis (3.95% tetrahydrocannabinol daily), ingest dronobinol (2.5 mg daily), or ingest a placebo daily (Abrams et al, 2003).…”