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

Abstract

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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References

  1. 1.

    Abrams DI, Hilton JF, Leiser RJ, Shade SB, Elbeik TA, Aweeka FT, Schambelan M. Short-term effects of cannabinoids in patients with HIV-1 infection: a randomized, placebo-controlled clinical trial. Ann Intern Med. 2003;139(4):258.

    CAS  PubMed  Article  Google Scholar 

  2. 2.

    Abrams DI, Jay CA, Shade SB, Vizoso H, Reda H, Press S, Petersen KL. Cannabis in painful HIV-associated sensory neuropathy: a randomized placebo-controlled trial. Neurology. 2007;68(7):515–21.

    CAS  PubMed  Article  Google Scholar 

  3. 3.

    Arnsten J, Demas P, Grant R, Gourevitch M, Farzadegan H, Howard A, Schoenbaum E. Impact of active drug use on antiretroviral therapy adherence and viral suppression in HIV-infected drug users. J Gen Intern Med. 2002;17(5):377–81.

    PubMed Central  PubMed  Article  Google Scholar 

  4. 4.

    Belle-Isle L, Hathaway A. Barriers to access to medical cannabis for canadians living with HIV/AIDS. AIDS Care. 2007;19(4):500–6.

    CAS  PubMed  Article  Google Scholar 

  5. 5.

    Bonn-Miller MO, Oser ML, Buccosi MB, Trafton JA. (2012) Cannabis use and HIV antiretroviral therapy adherence and HIV-related symptoms. J Behav Med, 12 October 2012. [Epub ahead of print].

  6. 6.

    Bouhnik AD, Preau M, Vincent E, Carrieri MP, Gallais H, Lepeu G, et al. Depression and clinical progression in HIV-infected DU treated with highly active antiretroviral therapy. Antivir Ther. 2005;10:53–61.

    CAS  PubMed  Google Scholar 

  7. 7.

    Carrieri MP, Chesney MA, Spire B, Loundou A, Sobel A, Lepeu G, Moatti JP. Failure to maintain adherence to HAART in a cohort of french HIV-positive injecting drug users. Int J Behav Med. 2003;10(1):1–14.

    CAS  PubMed  Article  Google Scholar 

  8. 8.

    Cescon AM, Cooper C, Chan K, Palmer AK, Klein MB, Machouf N, Loutfy MR, Raboud J, Rachlis A, Ding E, Lima VD, Montaner JSG, Rourke SB, Smieja M, Tsoukas C, Hogg RS. Factors associated with virological suppression among HIV-positive individuals on highly active antiretroviral therapy in a multi-site canadian cohort. HIV Medicine. 2011;12(6):352–60.

    CAS  PubMed  Article  Google Scholar 

  9. 9.

    Corless IB, Lindgren T, Holzemer W, Robinson L, Moezzi S, Kirksey K, Reynolds N. Marijuana effectiveness as an HIV self-care strategy. Clin Nurs Res. 2009;18(2):172–93.

    PubMed  Article  Google Scholar 

  10. 10.

    Crisp BR, Williams M, Timpson S, Ross MW. Medication compliance and satisfaction with treatment for HIV disease in a sample of african-american crack cocaine smokers. AIDS Behav. 2004;8(2):199–206.

    PubMed  Article  Google Scholar 

  11. 11.

    Cristiani S, Pukay-Martin N, Bornstein B. Marijuana use and cognitive function in HIV-infected people. J Neuropsychiatry Clin Neurosci. 2004;16(3):330–5.

    PubMed  Article  Google Scholar 

  12. 12.

    de Jong B, Prentiss D, McFarland W, Machekano R, Israelski D. Marijuana use and its association with adherence to antiretroviral therapy among HIV-infected persons with moderate to severe nausea. JAIDS. 2005;38(1):43–6.

    PubMed  Google Scholar 

  13. 13.

    Department of Justice Canada. (2011). Marihuana medical access regulations. Accessed 12 Sept 2011, from http://lois-laws.justice.gc.ca/eng/regulations/SOR-2001-227/page-1.html.

  14. 14.

    Ellis RJ, Toperoff W, Vaida F, Van den B Gonzales J, Gouaux B, Atkinson JH. Smoked medicinal cannabis for neuropathic pain in HIV: a randomized, crossover clinical trial. Neuropsychopharmacology. 2009;34(3):672–80.

    CAS  PubMed Central  PubMed  Article  Google Scholar 

  15. 15.

    Fogarty A, Rawstorne P, Prestage G, Crawford J, Grierson J, Kippax S. Marijuana as therapy for people living with HIV/AIDS: social and health aspects. AIDS Care. 2007;19(2):295–301.

    CAS  PubMed  Article  Google Scholar 

  16. 16.

    Hadland SE, Milloy M-J, Kerr T, Zhang R, Guillemi S, Hogg R, Wood E. Young age predicts poor antiretroviral adherence and viral load suppression among injection drug users. AIDS Patient Care STDs. 2012;26(5):274–80.

    PubMed Central  PubMed  Article  Google Scholar 

  17. 17.

    Haney M, Gunderson EW, Rabkin J, Hart CL, Vosburg SK, Comer SD, Foltin RW. Dronabinol and marijuana in HIV-positive marijuana smokers: caloric intake, mood, and sleep. JAIDS. 2007;45(5):545–54.

    CAS  PubMed  Google Scholar 

  18. 18.

    Hinkin CH, Barclay TR, Castellon SA, Levine AJ, Durvasula RS, Marion SD, Longshore D. Drug use and medication adherence among HIV-1 infected individuals. AIDS Behav. 2007;11(2):185–94.

    PubMed Central  PubMed  Article  Google Scholar 

  19. 19.

    Kerr T, Walsh J, Lloyd-Smith E, Wood E. Measuring adherence to highly active anteretroviral therapy: implications for research and practice. Current HIV/AIDS Report. 2005;2(4):200–5.

    Article  Google Scholar 

  20. 20.

    Kerr T, Hogg RS, Yip B, Tyndall MW, Montaner J, Wood E. Validity of self-reported adherence among injection drug users. JIAPAC. J Int Assoc Physicians AIDS Care. 2008;7(4):157–9.

    Article  Google Scholar 

  21. 21.

    Larsen MV, Omland LH, Gerstoft J, Larsen CS, Jensen J, Obel N, Kronborg G. Impact of injecting drug use on mortality in Danish HIV-infected patients: a nation-wide population-based cohort study. Addiction. 2010;105(3):529–35.

    PubMed  Article  Google Scholar 

  22. 22.

    Lewden C, Bouteloup V, De Wit S, Sabin C, Mocroft A, Wasmuth JC, van Sighem A, Kirk O, Obel N, Panos G, Ghosn J, Dabis F, Mary-Krause M, Leport C, Perez-Hoyos S, Sobrino-Vegas P, Stephan C, Castagna A, Antinori A, d’Arminio Monforte A, Torti C, Mussini C, Isern V, Calmy A, Teira R, Egger M, Grarup J, Chêne Gl. All-cause mortality in treated HIV-infected adults with CD4 ≥ 500/mm3 compared with the general population: evidence from a large European observational cohort collaboration. Int J Epidemiol. 2012;41(2):433–45.

    PubMed  Article  Google Scholar 

  23. 23.

    Low-Beer S, Chan K. Depressive symptoms decline among persons on HIV protease inhibitors. JAIDS. 2000;23(4):295.

    CAS  PubMed  Google Scholar 

  24. 24.

    Lucas GM, Cheever LW, Chaisson RE, Moore RD. Detrimental effects of continued illicit drug use on the treatment of HIV-1 infection. JAIDS. 2001;27(3):251.

    CAS  PubMed  Google Scholar 

  25. 25.

    Maldonado G, Greenland S. Simulation study of confounder-selection strategies. Am J Epidemiol. 1993;138(11):923–36.

    CAS  PubMed  Google Scholar 

  26. 26.

    Malta M, Strathdee SA, Magnanini MMF, Bastos FI. Adherence to antiretroviral therapy for human immunodeficiency virus/acquired immune deficiency syndrome among drug users: a systematic review. Addiction. 2008;103(8):1242–57.

    PubMed  Article  Google Scholar 

  27. 27.

    Marshall BD, Kerr T, Shoveller JA, Patterson TL, Buxton JA, Wood E. Homelessness and unstable housing associated with an increased risk of HIV and STI transmission among street-involved youth. Health Place. 2009;15(3):753–60.

    PubMed Central  PubMed  Article  Google Scholar 

  28. 28.

    May MT, Sterne JAC, Costagliola D, Sabin CA, Phillips AN, Justice AC, Dabis F, Gill J, Lundgren J, Hogg RS, de Wolf F, Fätkenheuer G, Staszewski S, d’Arminio MA, Egger M. HIV treatment response and prognosis in europe and north america in the first decade of highly active antiretroviral therapy: a collaborative analysis. Lancet. 2006;368(9534):451–8.

    PubMed  Article  Google Scholar 

  29. 29.

    Milloy MJ, Kerr T, Buxton J, Rhodes T, Guillemi S, Hogg R, Wood E. Dose-response effect of incarceration events on nonadherence to HIV antiretroviral therapy among injection drug users. J Infect Dis. 2011;203(9):1215–21.

    CAS  PubMed Central  PubMed  Article  Google Scholar 

  30. 30.

    Milloy M-J, Kerr T, Bangsberg DR, Buxton J, Parashar S, Guillemi S, Wood E. Homelessness as a structural barrier to effective antiretroviral therapy among HIV-seropositive illicit drug users in a canadian setting. AIDS Patient Care STDs. 2012;26(1):60–7.

    PubMed Central  PubMed  Article  Google Scholar 

  31. 31.

    Nolan S, Milloy M, Zhang R, Kerr T, Hogg RSG, Wood E. Adherence and plasma HIV RNA response to antiretroviral therapy among HIV-seropositive injection drug users in a canadian setting. AIDS Care. 2011;23(8):980–7.

    PubMed  Article  Google Scholar 

  32. 32.

    Obel N, Omland LH, Kronborg G, Larsen CS, Pedersen C, Pedersen G, Sorensen HT, Gerstoft J. Impact of non-HIV and HIV risk factors on survival in HIV-infected patients on HAART: a population-based nationwide cohort study. PLoS ONE. 2011;6(7):e22698.

    CAS  PubMed Central  PubMed  Article  Google Scholar 

  33. 33.

    Palepu A, Tyndall MW, Joy R, Kerr T, Wood E, Press N, Montaner J. Antiretroviral adherence and HIV treatment outcomes among HIV/HCV co-infected injection drug users: the role of methadone maintenance therapy. Drug Alcohol Depend. 2006;84(2):188–94.

    PubMed  Article  Google Scholar 

  34. 34.

    Palepu A, Yip B, Miller C, Strathdee SA, O’Shaughnessy MV, Montaner JS, Hogg RS. Factors associated with the response to antiretroviral therapy among HIV-infected patients with and without a history of injection drug use. AIDS. 2001;15(3):423–4.

    CAS  PubMed  Article  Google Scholar 

  35. 35.

    Palepu A, Milloy M-J, Kerr T, Zhang R, Wood E. Homelessness and adherence to antiretroviral therapy among a cohort of HIV-infected injection drug users. J Urban Health. 2011;88(3):545–55.

    PubMed Central  PubMed  Article  Google Scholar 

  36. 36.

    Palepu A, Tyndall MW, Chan K, Wood E, Montaner JSG, Hogg RS. Initiating highly active antiretroviral therapy and continuity of HIV care: the impact of incarceration and prison release on adherence and HIV treatment outcomes. Antivir Ther. 2004;9(5):713–9.

    PubMed  Google Scholar 

  37. 37.

    Prentiss D, Power R, Balmas G, Tzuang G, Israelski DM. Patterns of marijuana use among patients with HIV/AIDS followed in a public health care setting. JAIDS. 2004;35(1):38–45.

    PubMed  Google Scholar 

  38. 38.

    Radloff LS. The CES-D scale: a self-report depression scale for research in the general population. Appl Psychol Meas. 1977;1(3):385–401.

    Article  Google Scholar 

  39. 39.

    Richardson L, Wood E, Li K, Kerr T. Factors associated with employment among a cohort of injection drug users. Drug Alcohol Rev. 2010;29(3):293–300.

    PubMed  Article  Google Scholar 

  40. 40.

    Sangsari S, Milloy MJ, Ibrahim A, Kerr T, Zhang R, Montaner J, and Wood E. Physician experience and rates of plasma HIV-1 RNA suppression among illicit drug users: An observational study. BMC Infect Dis. 2012;12:22.

  41. 41.

    Sharpe TT, Lee LM, Nakashima AK, Elam-Evans L, Fleming PL. Crack cocaine use and adherence to antiretroviral treatment among HIV-infected black women. J Community Health. 2004;29(2):117–27.

    PubMed  Article  Google Scholar 

  42. 42.

    Tapp C, Milloy M, Kerr T, Zhang R, Guillemi S, Hogg RS, Wood E. Female gender predicts lower access and adherence to antiretroviral therapy in a setting of free healthcare. BMC Infect Dis. 2011;11:86.

    PubMed Central  PubMed  Article  Google Scholar 

  43. 43.

    Ware MA, Rueda S, Singer J, Kilby D. Cannabis use by persons living with HIV/AIDS: patterns and prevalence of use. J Cannabis Ther. 2003;3(2):3–15.

    Article  Google Scholar 

  44. 44.

    Wilson K, Doxanakis A, Fairley K. Predictors for non-adherence to antiretroviral therapy. Sexual Health. 2004;1(4):251–7.

    CAS  PubMed  Article  Google Scholar 

  45. 45.

    Wood E, Hogg RS, Yip B, Harrigan PR, O’Shaughnessy M, Montaner J. Effect of medication adherence on survival of HIV-infected adults who start highly active antiretroviral therapy when the CD4+ cell count is 0.200 to 0.350 × 10(9) cells/L. Ann Intern Med. 2003;139(10):810.

    PubMed  Article  Google Scholar 

  46. 46.

    Wood E, Hogg RS, Lima VD, Kerr T, Yip B, Marshall BDL, Montaner JSG. Highly active antiretroviral therapy and survival in HIV-infected injection drug users. JAMA. 2008;300(5):550–4.

    CAS  PubMed  Article  Google Scholar 

  47. 47.

    Wood E, Hogg RS, Yip B, Harrigan PR, O’Shaughnessy MV, Montaner JSG. Is there a baseline CD4 cell count that precludes a survival response to modern antiretroviral therapy? AIDS. 2003;17(5):711–20.

    PubMed  Article  Google Scholar 

  48. 48.

    Wood E, Montaner JSG, Yip B, Tyndall MW, Schechter MT, O’Shaughnessy MV, Hogg RS. Adherence and plasma HIV RNA responses to highly active antiretroviral therapy among HIV-1 infected injection drug users. CMAJ. 2003;169(7):656–61.

    PubMed Central  PubMed  Google Scholar 

  49. 49.

    Woolridge E, Barton S, Samuel J, Osorio J, Dougherty A, Holdcroft A. Cannabis use in HIV for pain and other medical symptoms. J Pain Symptom Manage. 2005;29(4):358–67.

    PubMed  Article  Google Scholar 

  50. 50.

    Zvolensky MJ, Lewinsohn P, Bernstein A, Schmidt NB, Buckner JD, Seeley J, Bonn-Miller MO. Prospective associations between cannabis use, abuse, and dependence and panic attacks and disorder. J Psychiatr Res. 2008;42(12):1017–23.

    PubMed Central  PubMed  Article  Google Scholar 

  51. 51.

    Zwahlen M, Harris R, May M, Hogg R, Costagliola D, de Wolf F, Egger M. Mortality of HIV-infected patients starting potent antiretroviral therapy: Comparison with the general population in nine industrialized countries. [Mortality of HIV-infected patients starting potent antiretroviral therapy: comparison with the general population in nine industrialized countries.]. Int J Epidimiol. 2009;38(6):1624–33.

    Article  Google Scholar 

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Acknowledgments

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). https://doi.org/10.1007/s10461-014-0847-3

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Keywords

  • HIV/AIDS
  • Highly-active antiretroviral therapy
  • Adherence
  • Cannabis