Cannabis Use Not Linked to Heart Rhythm Problems in People Living with HIV | Research

The takeaway

Cannabis use showed no association with ECG abnormalities among 3,610 people with and without HIV in a decade-long cohort study.

HIV clinicians, cardiologists treating PWH, cannabis medicine researchers

What the researchers found

Cannabis use was not significantly associated with ECG evidence of myocardial infarction (aOR 1.02) or other abnormalities (aOR 1.02) in adjusted analyses. HIV status and sex were more important determinants — female participants had more abnormal findings, and male PWH had higher odds of non-MI abnormalities compared to PWoH.

Why it matters

People living with HIV already face elevated cardiovascular risk. Knowing that cannabis use doesn't appear to add ECG-detectable cardiac harm provides important reassurance for the many PWH who use cannabis for symptom management.

The numbers in context

3,610 participants (63% PWH). 28% reported cannabis use. 59% had normal ECG findings. Adjusted ORs for cannabis and MI evidence: 1.02 (95% CI: 0.82-1.26). For other abnormalities: 1.02 (95% CI: 0.80-1.32). Male PWH had higher odds of non-MI abnormalities vs PWoH (aOR 1.35).

How the study worked

Baseline logistic regression analysis of 3,610 participants from the MACS/WIHS Combined Cohort Study (2007-2017), comparing ECG findings between cannabis users (28%) and non-users, with adjustment for demographic and clinical covariates.

What this study cannot tell us

Cross-sectional ECG analysis at baseline limits temporal conclusions. Self-reported cannabis use may be underreported. Cannot distinguish between different cannabis products, potencies, or consumption methods. Residual confounding possible.

How to read the evidence

Large, well-characterized cohort with decade of follow-up provides moderate evidence, limited by cross-sectional ECG analysis and self-reported exposure.

When this study was published

Published 2026, analyzing 2007-2017 MACS/WIHS data.

The bigger picture

As cannabis becomes more widely used for managing HIV-related symptoms like pain, nausea, and appetite loss, understanding its cardiovascular safety profile in this population is critical for informed clinical decision-making.

Questions still open

Would more sensitive cardiac imaging detect subclinical changes? Do specific cannabis metabolites or usage patterns affect cardiovascular risk differently? What role does antiretroviral therapy play in modifying any cannabis-heart interaction?

Common questions

Does cannabis affect heart health in people with HIV?

In this study of over 3,600 people, cannabis use showed no association with ECG abnormalities — the odds ratios were essentially 1.0 — suggesting cannabis doesn't add detectable cardiac risk on top of HIV.

What does affect heart risk in people with HIV?

HIV status itself and sex were more important factors. Male people living with HIV had 35% higher odds of non-MI ECG abnormalities, and female participants had more abnormal findings overall than males.

Read the original research

The Association Between Cannabis Use and Electrocardiographic Abnormalities in People Living With HIV.

Journal of acquired immune deficiency syndromes (1999), 101(2), 191-198

View on PubMed ↗Publisher’s paper ↗

Citation

Larson, Michaela E; Pan, Yue; Lakhani, Fatima; Chavez, Jennifer V; Santana, Andrea; Nogueira, Nicholas Fonseca; Lieberman, Adam; Riley, Elise D; Wu, Katherine C; Tien, Phyllis; Kizer, Jorge; Floris-Moore, Michelle; Pyslar, Nataliya; Palella, Frank J; Witt, Mallory D; Magnani, Jared W; Plankey, Michael; Lazar, Jason; Sharma, Anjali; Moran, Caitlin; Topper, Elizabeth; Fox, Ervin; Kambrakos, Litsa; Fischl, Margaret; Jones, Deborah L; Alcaide, Maria L; Vidot, Denise; Martinez, Claudia. (2026). The Association Between Cannabis Use and Electrocardiographic Abnormalities in People Living With HIV.. Journal of acquired immune deficiency syndromes (1999), 101(2), 191-198. https://doi.org/10.1097/QAI.0000000000003786