Effect of marijuana smoking on pulmonary disease in HIV-infected and uninfected men: a longitudinal cohort study

Abstract

Background: Lung disease is a common comorbidity in people with HIV/AIDS, independent of smoking status. The effects of marijuana smoking on risk of lung disease in HIV-infected individuals are unclear.

Methods: In this prospective cohort study, we quantified lung disease risk among men enrolled in the Multicenter AIDS Cohort Study (MACS), a long-term observational cohort of HIV-infected and uninfected men who have sex with men. Eligible participants were aged ≥30 years with self-reported marijuana and tobacco smoking data from biannual study visits between 1996 and 2014. Pulmonary diagnoses were obtained from self-report and medical records. Analyses were performed using Cox models and Generalized Estimating Equations adjusted for tobacco smoking, CD4 T cell count, and other risk factors.

Findings: 1,630 incident pulmonary diagnoses were reported among 1,352 HIV-seropositive and 1,352 HIV-seronegative eligible participants matched for race and baseline age (53,794 total person-visits, median follow-up 10.5 years). 27% of HIV-infected participants reported daily or weekly marijuana smoking for one or more years in follow-up, compared to 18% of uninfected participants (median 4·0 and 4·5 years daily/weekly use, respectively). HIV-infected participants had an increased likelihood of infectious or non-infectious pulmonary diagnoses compared to uninfected participants (33·2% vs. 21·5%, and 20·6% vs. 17·2%, respectively). Among HIV-infected participants, recent marijuana smoking was associated with increased risk of infectious pulmonary diagnoses and chronic bronchitis independent of tobacco smoking and other risk factors for lung disease (hazard ratio [95% confidence interval] 1·43 [1·09-1·86], and 1·54 [1·11-2·13], respectively); these risks were additive in participants smoking both substances. There was no association between marijuana smoking and pulmonary diagnoses in HIV-uninfected participants.

Interpretation: In this longitudinal study, long-term marijuana smoking was associated with lung disease independent of tobacco smoking and other risk factors in HIV-infected individuals. These findings could be used to reduce modifiable risks of lung disease in high-risk populations.

Fig. 1

Cohort selection flowchart.

Fig. 2

Cumulative hazards of infectious pulmonary and chronic bronchitis by marijuana and tobacco smoking in HIV+ participants. Estimated cumulative hazard curves from Cox regression models of (A) infectious pulmonary diagnoses (Table 3, HIV+ Model 1), and (B) chronic bronchitis (Table 5, HIV+ Model 1). Estimates were obtained holding other model covariates at their mean values; curves were right-truncated at age 65, corresponding to 10% of participants at risk remaining. MJ+ denotes daily or weekly current marijuana smoking, MJ−, monthly smoking or less, TS+, ≥ 1/2 pack/day tobacco smoking, prior two-year average, TS−, 0 packs/day tobacco smoking, prior two-year average.