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. 2023 Jan 5;10(1):ofac699.
doi: 10.1093/ofid/ofac699. eCollection 2023 Jan.

Cannabis Use Is Associated With Decreased Antiretroviral Therapy Adherence Among Older Adults With HIV

Jennifer A Manuzak  1 , Janeway Granche  2 , Katherine Tassiopoulos  3 , Joseph E Rower  4 , Justin R Knox  5   6   7 , Dionna W Williams  8   9 , Ronald J Ellis  10 , Karl Goodkin  11   12 , Anjali Sharma  13 , Kristine M Erlandson  14 ; AIDS Clinical Trials Group (ACTG) A5322 Study Team
Affiliations

Cannabis Use Is Associated With Decreased Antiretroviral Therapy Adherence Among Older Adults With HIV

Jennifer A Manuzak et al. Open Forum Infect Dis. .

Abstract

Background: Conflicting evidence exists on the impact of cannabis use on antiretroviral therapy (ART) adherence among people with human immunodeficiency virus (PWH). We leveraged data collected among older PWH to characterize longitudinal associations between cannabis use and ART adherence.

Methods: AIDS Clinical Trials Group (ACTG) A5322 study participants were categorized as <100% (≥1 missed dose in past 7 days) or 100% (no missed doses) ART adherent. Participants self-reported current (past month), intermittent (past year but not past month), and no cannabis (in past year) use at each study visit. Generalized linear models using generalized estimating equations were fit and inverse probability weighting was used to adjust for time-varying confounders and loss to follow-up.

Results: Among 1011 participants (median age, 51 years), 18% reported current, 6% intermittent, and 76% no cannabis use at baseline; 88% reported 100% ART adherence. Current cannabis users were more likely to be <100% adherent than nonusers (adjusted risk ratio [aRR], 1.53 [95% CI, 1.11-2.10]). There was no association between ART adherence and current versus intermittent (aRR, 1.39 [95% CI, .85-2.28]) or intermittent versus no cannabis use (aRR, 1.04 [95% CI, .62-1.73]).

Conclusions: Among a cohort of older PWH, current cannabis users had a higher risk of <100% ART adherence compared to nonusers. These findings have important clinical implications as suboptimal ART adherence is associated with ART drug resistance, virologic failure, and elevated risk for mortality. Further research is needed to elucidate the mechanisms by which cannabis use decreases ART adherence in older PWH and to advance the development of more efficacious methods to mitigate nonadherence in this vulnerable population.

Keywords: HIV; adherence; aging; antiretroviral therapy; cannabis.

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Conflict of interest statement

Potential conflicts of interest. K. M. E. has received grant support from Gilead Sciences and consulting/advising payments from ViiV, Gilead, and Janssen Pharmaceuticals, all paid to the University of Colorado. K. G. has previously received support from Eli Lilly and Janssen Pharmaceuticals. All other authors report no conflicts of interest.

Figures

Figure 1.
Figure 1.
Associations between cannabis use and antiretroviral therapy (ART) adherence among older people with human immunodeficiency virus. Generalized linear models using generalized estimating equations were used to estimate the association between cannabis use and ART adherence. Data are depicted as a forest plot of the nonadherence risk ratio (RR with 95% confidence interval [CI]). *Inverse probability (IP)–weighted for dropout. **Adjusted for baseline covariates (sex, race/ethnicity, educational level, smoking status, time on ART, cannabis use history) and IP-weighted for dropout and time-varying exposures (alcohol use, other substance use, ART adherence history).
Figure 2.
Figure 2.
Relationship between cannabis use and antiretroviral therapy (ART) adherence by sex assigned at birth. Models that included interaction terms for time × sex assigned at birth were used to evaluate whether the association between cannabis use and ART adherence varied among participants by sex assigned at birth. Data are depicted as a forest plot of the nonadherence risk ratio (RR with 95% confidence interval [CI]). *Inverse probability (IP)–weighted for dropout. **Adjusted for baseline covariates (race/ethnicity, educational level, smoking status, time on ART, cannabis use history) and IP-weighted for dropout and time-varying exposures (alcohol use, other substance use, ART adherence history).
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