Adults With HIV Are 3.35 Times More Likely to Co-use Tobacco and Cannabis | Research

The takeaway

Analysis of 139,524 US adults found those with HIV were 3.35 times more likely to co-use tobacco and cannabis, with the association modified by race/ethnicity and state-level medical cannabis laws.

HIV clinicians, tobacco cessation specialists, and substance use researchers.

3.35x higher odds of tobacco-cannabis co-use among adults with HIV

What the researchers found

Adults with HIV had 3.35x higher odds of past-month tobacco-cannabis co-use (aRRR=3.35, 95% CI: 1.79-6.27). 0.4% of respondents reported HIV; 8.2% reported tobacco-cannabis co-use. Race/ethnicity and state medical cannabis legalization modified the HIV-co-use association.

Why it matters

Tobacco-cannabis co-use poses unique health risks including lung disease, drug dependence, and potential ART interactions. The high co-use rate among PWH demands targeted harm reduction strategies.

The numbers in context

139,524 adults; 0.4% HIV+; 8.2% co-use; aRRR=3.35 for HIV and co-use; race/ethnicity and state laws modified association.

How the study worked

Cross-sectional analysis of 2021-2023 National Survey on Drug Use and Health. 139,524 adult respondents. Adjusted multinomial logistic regression with interaction testing for demographics and state cannabis laws.

What this study cannot tell us

Cross-sectional design. Self-reported HIV diagnosis may undercount. Cannot determine temporal order. NSDUH household survey may miss homeless/institutionalized populations.

How to read the evidence

Very large nationally representative sample with detailed subgroup analysis. Cross-sectional design limits causal inference.

When this study was published

2025 analysis of 2021-2023 NSDUH data.

The bigger picture

As HIV becomes a chronic condition and cannabis legalizes, the intersection of HIV, tobacco, and cannabis creates complex clinical scenarios that most providers are not trained to address.

Questions still open

Should HIV care routinely screen for tobacco-cannabis co-use?
Does medical cannabis legalization encourage or reduce harmful co-use patterns among PWH?

Common questions

Do people with HIV use more cannabis and tobacco together?

Yes. Adults with HIV were 3.35 times more likely to co-use tobacco and cannabis compared to those without HIV.

Does state cannabis law matter?

Yes. State-level medical cannabis legalization status modified the association between HIV and tobacco-cannabis co-use.

Read the original research

Tobacco and Cannabis Co-use by HIV Status Among United States Adults: Results from the 2021-2023 National Survey on Drug Use and Health.

AIDS and behavior, 29(12), 3794-3805

View on PubMed ↗Publisher’s paper ↗

Citation

Lee, Juhan; Yin, Ana Paula Xingru; Weinberger, Andrea H. (2025). Tobacco and Cannabis Co-use by HIV Status Among United States Adults: Results from the 2021-2023 National Survey on Drug Use and Health.. AIDS and behavior, 29(12), 3794-3805. https://doi.org/10.1007/s10461-025-04817-5