Among 1,010 HIV-positive patients starting antiretroviral therapy, cannabis use was associated with twice the odds of having a detectable viral load but no differences in immune cell counts or BMI.
HIV clinicians, infectious disease specialists, and patients managing HIV with cannabis use.
Cannabis users had 2x the odds of detectable HIV viral load
What the researchers found
In a retrospective cohort of 1,010 HIV-positive adults starting their first ART regimen (4,290 visits, 2008-2011), cannabis use was associated with greater odds of detectable viral load (OR 2.02 for ever-use during study, OR 1.72 for any use in past 7 days). Cannabis use was not associated with changes in CD4+ T-cell count or BMI.
Why it matters
Cannabis use is common among HIV-positive individuals, but evidence on how it affects treatment outcomes is limited. The association with detectable viral loads may reflect adherence differences rather than a direct pharmacological effect.
The numbers in context
1,010 patients; 4,290 visits (2008-2011); ever cannabis use OR 2.02 for detectable viral load; no significant differences in CD4 count or BMI.
How the study worked
Retrospective cohort study of 1,010 HIV-positive adults initiating first ART regimen, with self-reported cannabis use assessed at each visit. Random effects models adjusted for age, sex, race, and other substance use.
What this study cannot tell us
Self-reported cannabis use (likely underreported); retrospective design; cannot distinguish whether cannabis directly affects viral suppression or is a marker for adherence difficulties; single-center study.
How to read the evidence
Moderate: reasonable sample size with adjusted models, but retrospective and self-reported cannabis use.
When this study was published
Published 2020.
The bigger picture
The finding may relate to adherence rather than a biological interaction between cannabis and ART. If cannabis users are less likely to take their medications consistently, that would explain the viral load association without implicating cannabis itself.
Questions still open
- Is the viral load association driven by adherence differences? Would controlling for medication adherence eliminate the association?
Common questions
Does cannabis interfere with HIV treatment?
Should HIV patients avoid cannabis?
Read the original research
Self-reported Cannabis Use and Changes in Body Mass Index, CD4 T-Cell Counts, and HIV-1 RNA Suppression in Treated Persons with HIV.
AIDS and behavior, 24(4), 1275-1280
Citation
Lee, James T; Saag, Lauren A; Kipp, Aaron M; Logan, James; Shepherd, Bryan E; Koethe, John R; Turner, Megan; Bebawy, Sally; Sterling, Timothy R; Hulgan, Todd. (2020). Self-reported Cannabis Use and Changes in Body Mass Index, CD4 T-Cell Counts, and HIV-1 RNA Suppression in Treated Persons with HIV.. AIDS and behavior, 24(4), 1275-1280. https://doi.org/10.1007/s10461-019-02430-x
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