Regular Cannabis Use by Older People Living with HIV Is Associated with a Greater Risk of Imperfect Adherence to Antiretroviral Therapy

Cannabis is commonly used among people living with HIV in the United States to relieve pain, nausea, vomiting, and the loss of appetite that sometimes is caused by HIV or its treatments. As a result, it has been viewed by some as an unapproved HIV treatment for decades. And yet, its potential risks and side effects aren’t completely understood, and there is conflicting evidence on its impact on the clinical care of people living with HIV, particularly among older adults.

Jennifer Manuzak led a team of researchers who looked at data collected through the HAILO Study (A5322), an observational study of people 40 years or older who are living with HIV, are in long-term follow-up, and received their first ART regimen through select ACTG clinical trials. The team longitudinally evaluated associations between self-reported cannabis use and ART adherence among this group.

In HAILO, participants completed a yearly questionnaire, self-reporting cannabis use in response to the following question, “When was the last time you used marijuana (pot, hashish)?” by answering: (0) never used; (1) less than 1 year ago; (2) within the past year up until 1 month ago; or (3) within the past month. Participants were classified as nonusers if they answered (0) or (1), intermittent users if they answered (2), or current users if they answered (3). Since cannabis use was measured yearly, only the data on ART adherence that was obtained during the same annual visits was used in the current analyses.

A total of 963 participants contributed up to six years of data. At the start of HAILO, 18% of participants reported current cannabis use, 6% intermittent use, and 76% non-use, while 88% of participants reported 100% ART adherence. Mean age at the start of the study was 51 years, 81% of participants were male at birth, and 49% identified as White non-Hispanic, 30% as Black non-Hispanic, 18% as Hispanic and 2% another race/ethnicity.

The study found that participants who reported current cannabis use were more likely to be less than 100% ART adherent than non-users. This association was maintained even when adjusted for demographic and behavioral characteristics. There was no association between intermittent vs non-use and ART adherence. These findings were consistent among male participants, but not female participants, potentially indicating sex-specific effects of cannabis exposure on ART adherence.

This is among the first studies to show these relationships among older people living with HIV and it will be important to better understand how cannabis use may interact with other common factors among this population (e.g., enhanced neurocognitive impairment) and lead to ART nonadherence.

Further investigation is needed to clarify the bio-behavioral and sex-specific mechanisms associated with cannabis use that lead to decreased ART adherence in older people living with HIV and to understand the potential risks of developing comorbid conditions among older people living with HIV that use cannabis. Additional research is also needed to better understand how to balance the potential benefits of cannabis use to reduce inflammation and immune activation against possible risks to ART adherence in older people living with HIV.

Manuzak, J. A., Granche, J., Tassiopoulos, K., Rower, J. E., Knox, J. R., Williams, D. W., Ellis, R. J., Goodkin, K., Sharma, A., Erlandson, K. M., & AIDS Clinical Trials Group (ACTG) A5322 Study Team (2023). Cannabis Use Is Associated With Decreased Antiretroviral Therapy Adherence Among Older Adults With HIV. Open forum infectious diseases10(1), ofac699.