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High-Intensity Cannabis Use and Adherence to Antiretroviral Therapy Among People Who Use Illicit Drugs in a Canadian Setting


Cannabis is increasingly prescribed clinically and utilized by people living with HIV/AIDS (PLWHA) to address symptoms of HIV disease and to manage side effects of antiretroviral therapy (ART). In light of concerns about the possibly deleterious effect of psychoactive drug use on adherence to ART, we sought to determine the relationship between high-intensity cannabis use and adherence to ART among a community-recruited cohort of HIV-positive illicit drug users. We used data from the ACCESS study, an ongoing prospective cohort study of HIV-seropositive illicit drug users linked to comprehensive ART dispensation records in a setting of universal no-cost HIV care. We estimated the relationship between at least daily cannabis use in the last 6 months, measured longitudinally, and the likelihood of optimal adherence to ART during the same period, using a multivariate linear mixed-effects model accounting for relevant socio-demographic, behavioral, clinical and structural factors. From May 2005 to May 2012, 523 HIV-positive illicit drug users were recruited and contributed 2,430 interviews. At baseline, 121 (23.1 %) participants reported at least daily cannabis use. In bivariate and multivariate analyses we did not observe an association between using cannabis at least daily and optimal adherence to prescribed HAART (Adjusted Odds Ratio = 1.12, 95 % Confidence Interval [95 % CI]: 0.76–1.64, p value = 0.555.) High-intensity cannabis use was not associated with adherence to ART. These findings suggest cannabis may be utilized by PLWHA for medicinal and recreational purposes without compromising effective adherence to ART.

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We thank the study participants for their contributions to the research, as well as current and past researchers and staff. We would specifically like to thank Deborah Graham, Tricia Collingham, Carmen Rock, Brandon Marshall, Caitlin Johnston, Steve Kain, Benita Yip, Jennifer Matthews and Kristie Starr for their research and administrative assistance. The study is supported by the US National Institutes of Health (R01-DA021525). This work was supported in part by a Tier 1 Canada Research Chair in Inner-City Medicine awarded to Dr. Wood. Dr. Milloy is supported by the Michael Smith Foundation for Health Research and the Canadian Institutes of Health Research.

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Correspondence to Thomas Kerr.

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Slawson, G., Milloy, MJ., Balneaves, L. et al. High-Intensity Cannabis Use and Adherence to Antiretroviral Therapy Among People Who Use Illicit Drugs in a Canadian Setting. AIDS Behav 19, 120–127 (2015).

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  • Highly-active antiretroviral therapy
  • Adherence
  • Cannabis