Self-Reported Cannabis Use and HIV Viral Control among Patients with HIV Engaged in Care: Results from a National Cohort Study
Abstract
:1. Introduction
2. Methods
2.1. Study Design and Data Sources
2.2. Study Population
2.3. Study Measures
2.4. Statistical Analyses
3. Results
3.1. Eligible Participants
3.2. Baseline Participant Characteristics
3.3. Factors Associated with Cannabis Use: Bivariable Analyses
3.4. Association between Cannabis Use and HIV Viral Load
4. Discussion
4.1. Limitations
4.2. Future Research
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Characteristic | Overall (n = 2515) | No Past-Year Use (n = 1830, 72.8%) | Past-Year Use (n = 685, 27.2%) | Global p-Value |
---|---|---|---|---|
Demographics | ||||
Age, mean (SD) | 50.1 (8.8) | 50.6 (9.0) | 48.7 (8.2) | <0.0001 |
Gender, n (%) | 0.494 | |||
Male | 2447 (97.3) | 1783 (97.4) | 664 (96.9) | |
Female | 68 (2.7) | 47 (2.6) | 21 (3.1) | |
Race/ethnicity, n (%) | 0.160 | |||
Non-Hispanic White | 524 (20.8) | 363 (19.8) | 161 (23.5) | |
Non-Hispanic Black | 1646 (65.5) | 1214 (66.3) | 432 (63.1) | |
Hispanic (any race) | 247 (9.8) | 185 (10.1) | 62 (9.1) | |
Other (multiple race or unknown) | 98 (3.9) | 68 (3.7) | 30 (4.4) | |
Education, n (%) | 0.077 | |||
High school or less | 987 (39.7) | 736 (40.8) | 251 (36.9) | |
Some college or more | 1500 (60.3) | 1070 (59.3) | 430 (63.1) | |
Marital status, n (%) | 0.159 | |||
Never married | 610 (24.6) | 440 (24.4) | 170 (25.2) | |
Married/living with a partner | 981 (39.6) | 734 (40.7) | 247 (36.7) | |
Divorced/widowed | 885 (35.7) | 628 (34.9) | 257 (38.1) | |
Housing instability ever, n (%) | 982 (39.3) | 680 (37.4) | 302 (44.3) | 0.002 |
Location of residence, n (%) | 0.512 | |||
Urban | 2368 (95.0) | 1726 (95.2) | 642 (94.3) | |
Suburban | 70 (2.8) | 50 (2.8) | 20 (2.9) | |
Rural | 56 (2.3) | 37 (2.0) | 19 (2.8) | |
Annual income, n (%) | 0.013 | |||
<$11,999 | 1213 (49.8) | 859 (48.6) | 354 (53.2) | |
$12,000–$49,999 | 1038 (42.6) | 761 (43.0) | 277 (41.6) | |
≥$50,000 | 184 (7.6) | 149 (8.4) | 35 (5.3) | |
Social Isolation Score | 0.032 | |||
<4 | 680 (27.0) | 516 (28.2) | 164 (23.9) | |
≥4 | 1835 (73.0) | 1314 (71.8) | 521 (76.1) | |
HIV-related factors | ||||
CD4 cell count, cells/mm3, median (IQR) | 374 (228, 568) | 377 (231, 578) | 365 (219, 549) | 0.295 |
HIV viral load <500 copies/mL, n (%) | 1690 (67.2) | 1259 (68.8) | 431 (62.9) | 0.005 |
VACS Index 2.0 score, median (IQR) | 56 (46, 66) | 56 (46, 66) | 56 (46, 67) | 0.109 |
ART adherent, n (%) | 1551 (61.7) | 1164 (63.6) | 387 (56.5) | 0.001 |
Other health conditions and status, n (%) | ||||
HCV co-infection | 929 (36.9) | 664 (36.3) | 265 (38.7) | 0.267 |
Any cancer | 524 (20.8) | 375 (20.5) | 149 (21.8) | 0.489 |
Anxiety symptoms | 905 (37.1) | 619 (34.9) | 286 (42.9) | 0.0003 |
Depressive symptoms | 534 (21.5) | 347 (19.2) | 187 (27.5) | <0.0001 |
Pain interference | 830 (33.3) | 582 (32.1) | 248 (36.4) | 0.043 |
Other substance use, n (%) | ||||
Smokes cigarettes | 1915 (76.1) | 1337 (73.1) | 578 (84.4) | <0.0001 |
Unhealthy alcohol use | 876 (34.8) | 599 (32.7) | 277 (40.4) | 0.0003 |
Past-year stimulants or cocaine | 538 (21.4) | 252 (13.8) | 286 (41.8) | <0.0001 |
Prescribed opioid receipt, n (%) | 0.001 | |||
No opioid receipt | 1802 (71.7) | 1346 (73.6) | 456 (66.6) | |
Short-term + low dose | 449 (17.9) | 308 (16.8) | 141 (20.6) | |
Short-term + high dose | 40 (1.6) | 33 (1.8) | 7 (1.0) | |
Long-term + low dose | 159 (6.3) | 100 (5.5) | 59 (8.6) | |
Long-term + high dose | 65 (2.6) | 43 (2.4) | 22 (3.2) | |
Prescribed benzodiazepine | 0.336 | |||
None | 2147 (85.4) | 1573 (86.0) | 574 (83.8) | |
Low dose | 269 (10.7) | 190 (10.4) | 79 (11.5) | |
High dose | 99 (3.9) | 67 (3.7) | 32 (4.7) | |
Prescribed gabapentin | 0.320 | |||
None | 2240 (89.1) | 1639 (89.6) | 601 (87.7) | |
Low dose | 127 (5.1) | 91 (5.0) | 36 (5.3) | |
High dose | 148 (5.9) | 100 (5.5) | 48 (7.0) | |
Prescribed antidepressant | 0.017 | |||
None | 1557 (61.9) | 1161 (63.4) | 396 (57.8) | |
Short-term | 314 (12.5) | 227 (12.4) | 87 (12.7) | |
Long-term | 644 (25.6) | 442 (24.2) | 202 (29.5) | |
Site | 0.193 | |||
Atlanta | 403 (16.0) | 299 (16.3) | 104 (15.2) | |
Bronx | 258 (10.3) | 190 (10.4) | 68 (9.9) | |
Houston | 335 (13.3) | 242 (13.2) | 93 (13.6) | |
Los Angeles | 334 (13.3) | 225 (12.3) | 109 (15.9) | |
New York | 399 (15.9) | 295 (16.1) | 104 (15.2) | |
Baltimore | 282 (11.2) | 214 (11.7) | 68 (9.9) | |
Washington DC | 408 (16.2) | 302 (16.5) | 106 (15.5) | |
Pittsburgh | 96 (3.8) | 63 (3.4) | 33 (4.8) | |
Calendar year | 0.084 | |||
2002–2006 | 781 (31.5) | 583 (32.3) | 198 (29.3) | |
2007–2011 | 976 (39.3) | 717 (39.7) | 259 (38.3) | |
2012–2017 | 724 (29.2) | 505 (28.0) | 219 (32.4) | |
Average follow-up years, mean (SD) | 7.0 (3.7) | 6.9 (3.7) | 7.3 (3.7) | 0.030 |
Died during study | 904 (35.9) | 666 (36.4) | 238 (34.7) | 0.443 |
Unadjusted Odds Ratios [95% CI] | Model I, Adjusted Odds Ratios [95% CI] | Model II, Adjusted Odds Ratios [95% CI] | Model III, Adjusted Odds Ratios [95% CI] | Model IV, Adjusted Odds Ratios [95% CI] | |
---|---|---|---|---|---|
Past-year cannabis | 1.21 (1.07–1.37) | 1.10 (0.97–1.25) | 0.97 (0.85–1.11) | 1.02 (0.85–1.23) | 1.01 (0.83–1.22) |
Age | 0.95 (0.94, 0.95) | 0.95 (0.94–0.95) | 0.96 (0.95–0.97) | 0.96 (0.95–0.97) | |
Race/ethnicity | |||||
Non-Hispanic White | Ref | Ref | Ref | Ref | |
Non-Hispanic Black | 1.21 (1.02–1.43) | 1.15 (0.97–1.37) | 1.21 (0.97–1.50) | 1.12 (0.90–1.40) | |
Hispanic (any race) | 0.85 (0.65–1.10) | 0.82 (0.64–1.07) | 0.93 (0.67–1.29) | 0.93 (0.67–1.30) | |
Other (multiple race or unknown) | 1.00 (0.69–1.44) | 0.96 (0.66–1.40) | 1.19 (0.76–1.86) | 1.14 (0.72–1.79) | |
Sex | |||||
Male | Ref | Ref | Ref | Ref | |
Female | 0.62 (0.40–0.94) | 0.62 (0.41–0.95) | 0.64 (0.36–1.14) | 0.56 (0.32–0.97) | |
Unhealthy alcohol use | |||||
Yes | 1.14 (1.01–1.29) | 0.83 (0.70–0.98) | 0.78 (0.66–0.93) | ||
No | Ref | Ref | Ref | ||
Past-year stimulant/cocaine use | |||||
Yes | 1.56 (1.35–1.79) | 1.45 (1.18–1.79) | 1.37 (1.11–1.69) | ||
No | Ref | Ref | Ref | ||
Opioid Use | |||||
No opioid receipt | Ref | Ref | Ref | ||
Short-term + low dose | 1.02 (0.90–1.15) | 0.98 (0.81–1.20) | 0.97 (0.80–1.19) | ||
Short-term + high dose | 1.04 (0.67–1.60) | 1.86 (0.99–3.49) | 1.72 (0.92–3.24) | ||
Long-term + low dose | 1.21 (0.99–1.49) | 1.27 (0.93–1.73) | 1.25 (0.90–1.72) | ||
Long-term + high dose | 0.97 (0.70–1.35) | 0.82 (0.50–1.35) | 0.85 (0.52–1.40) | ||
Marital Status | |||||
Never married | Ref | Ref | |||
Married/living with a partner | 1.12 (0.88–1.43) | 1.10 (0.86–1.42) | |||
Divorced/widowed | 1.03 (0.80–1.33) | 1.01 (0.78–1.30) | |||
Homeless | |||||
Yes | 1.01 (0.84–1.22) | 0.98 (0.81–1.18) | |||
No | Ref | Ref | |||
Income | |||||
<$11,999 | Ref | Ref | |||
$12,000–$49,999 | 1.08 (0.90–1.30) | 1.07 (0.89–1.29) | |||
≥$50,000 | 1.04 (0.74–1.47) | 1.05 (0.75–1.49) | |||
Social score | |||||
<4 | Ref | Ref | |||
≥4 | 1.01 (0.81–1.26) | 1.03 (0.82–1.29) | |||
HCV | |||||
Yes | 0.98 (0.82–1.17) | 0.93 (0.78–1.12) | |||
No | Ref | Ref | |||
Anxiety | |||||
Yes | 1.04 (0.86–1.27) | 1.02 (0.84–1.24) | |||
No | Ref | Ref | |||
Depression | |||||
Yes | 1.13 (0.92–1.40) | 1.07 (0.86–1.32) | |||
No | Ref | Ref | |||
Smoking | |||||
Yes | 0.81 (0.66–0.99) | 0.83 (0.67–1.01) | |||
No | Ref | Ref | |||
Antidepressant | |||||
None | Ref | Ref | |||
Short-term | 1.24 (0.97–1.57) | 1.23 (0.96–1.58) | |||
Long-term | 1.13 (0.92–1.38) | 1.27 (1.03–1.55) | |||
ART adherence | |||||
Yes | 0.41 (0.35–0.48) | ||||
No | Ref |
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Share and Cite
Bahji, A.; Li, Y.; Vickers-Smith, R.; Crystal, S.; Kerns, R.D.; Gordon, K.S.; Macmadu, A.; Skanderson, M.; So-Armah, K.; Sung, M.L.; et al. Self-Reported Cannabis Use and HIV Viral Control among Patients with HIV Engaged in Care: Results from a National Cohort Study. Int. J. Environ. Res. Public Health 2022, 19, 5649. https://doi.org/10.3390/ijerph19095649
Bahji A, Li Y, Vickers-Smith R, Crystal S, Kerns RD, Gordon KS, Macmadu A, Skanderson M, So-Armah K, Sung ML, et al. Self-Reported Cannabis Use and HIV Viral Control among Patients with HIV Engaged in Care: Results from a National Cohort Study. International Journal of Environmental Research and Public Health. 2022; 19(9):5649. https://doi.org/10.3390/ijerph19095649
Chicago/Turabian StyleBahji, Anees, Yu Li, Rachel Vickers-Smith, Stephen Crystal, Robert D. Kerns, Kirsha S. Gordon, Alexandria Macmadu, Melissa Skanderson, Kaku So-Armah, Minhee L. Sung, and et al. 2022. "Self-Reported Cannabis Use and HIV Viral Control among Patients with HIV Engaged in Care: Results from a National Cohort Study" International Journal of Environmental Research and Public Health 19, no. 9: 5649. https://doi.org/10.3390/ijerph19095649