Self-reported Cannabis Use and Changes in Body Mass Index, CD4 T-Cell Counts, and HIV-1 RNA Suppression in Treated Persons with HIV


Cannabis use is prevalent among HIV-positive persons, but evidence regarding the impact of cannabis in HIV-positive persons is limited. We conducted a retrospective cohort study of HIV-positive adults initiating their first antiretroviral therapy (ART) regimen. A dedicated intake form assessed self-reported cannabis use in the preceding 7 days at each visit. The relationships between time-varying cannabis use and body mass index (BMI), CD4+ T-cell count, and HIV-1 RNA levels were assessed using random effects models adjusted for age, sex, race, and other reported substance use. 4290 patient-visits from 2008 to 2011 were available from 1010 patients. Overall, there were no statistically significant differences in CD4+ T-cell count and BMI across multiple adjusted models using different measures of cannabis use (ever use during the study period, any use, and number of times used in the preceding 7 days). Cannabis use by all three measures was associated with greater odds of having a detectable viral load at a given visit than no reported use (OR 2.02, 1.72, and 1.08, respectively; all adjusted p < 0.05). Self-reported cannabis use was not associated with changes in BMI or CD4+ T-cell count in ART-naïve HIV-positive persons starting treatment. However, reported cannabis use by multiple categories was associated with having a detectable HIV-1 RNA during the study period. Associations between cannabis use, adherence, and HIV-related outcomes merit further study.

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  1. 1.

    Rosen MI, Black AC, Arnsten JH, Goggin K, Remien RH, Simoni JM, et al. Association between use of specific drugs and antiretroviral adherence: findings from MACH 14. AIDS Behav. 2013;17(1):142–7.

    CAS  Article  Google Scholar 

  2. 2.

    Mimiaga MJ, Reisner SL, Grasso C, Crane HM, Safren SA, Kitahata MM, et al. Substance use among HIV-infected patients engaged in primary care in the United States: findings from the Centers for AIDS Research Network of Integrated Clinical Systems cohort. Am J Public Health. 2013;103(8):1457–67.

    Article  Google Scholar 

  3. 3.

    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.

    Article  Google Scholar 

  4. 4.

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

    Article  Google Scholar 

  5. 5.

    Okafor CN, Zhou Z, Burrell LE, Kelso NE, Whitehead NE, Harman JS, et al. Marijuana use and viral suppression in persons receiving medical care for HIV-infection. Am J Drug Alcohol Abuse. 2017;43(1):103–10.

    Article  Google Scholar 

  6. 6.

    National Conference of State Legislatures. State Medical Marijuana Laws. February 2018. Accessed 9 Feb 2018.

  7. 7.

    Geiger A. Support for marijuana legalization continues to rise. Pew Research Center. October 2016. Accessed 10 April 2017.

  8. 8.

    Devinsky O, Cross JH, Laux L, Marsh E, Miller I, Nabbout R, et al. Trial of Cannabidiol for Drug-Resistant Seizures in the Dravet Syndrome. N Engl J Med. 2017 25;376(21):2011–20.

  9. 9.

    Haney M, Gunderson EW, Rabkin J, Hart CL, Vosburg SK, Comer SD, et al. Dronabinol and marijuana in HIV-positive marijuana smokers Caloric intake, mood, and sleep. J Acquir Immune Defic Syndr. 2007;45(5):545–54.

    CAS  Article  Google Scholar 

  10. 10.

    Haney M, Rabkin J, Gunderson E, Foltin RW. Dronabinol and marijuana in HIV+ marijuana smokers: acute effects on caloric intake and mood. Psychopharmacology. 2005;181(1):170–8.

    CAS  Article  Google Scholar 

  11. 11.

    Beal JE, Olson R, Laubenstein L, Morales JO, Bellman P, Yangco B, et al. Dronabinol as a treatment for anorexia associated with weight loss in patients with AIDS. J Pain Symptom Manage. 1995;10(2):89–97.

    CAS  Article  Google Scholar 

  12. 12.

    Abrams DI, Hilton JF, Leiser RJ, Shade SB, Elbeik TA, Aweeka FT, et al. Short-term effects of cannabinoids in patients with HIV-1 infection: a randomized, placebo-controlled clinical trial. Ann Intern Med. 2003;139(4):258–66.

    CAS  Article  Google Scholar 

  13. 13.

    Koethe JR, Jenkins CA, Shepherd BE, Stinnette SE, Sterling TR. An optimal body mass index range associated with improved immune reconstitution among HIV-infected adults initiating antiretroviral therapy. Clin Infect Dis. 2011;53(9):952–60.

    CAS  Article  Google Scholar 

  14. 14.

    Bredt BM, Higuera-Alhino D, Shade SB, Hebert SJ, McCune JM, Abrams DI. Short-term effects of cannabinoids on immune phenotype and function in HIV-1-infected patients. J Clin Pharmacol. 2002;42(11 Suppl):82S–9S.

    CAS  Article  Google Scholar 

  15. 15.

    Lutge EE, Gray A, Siegfried N. The medical use of cannabis for reducing morbidity and mortality in patients with HIV/AIDS. Cochrane Database Syst Rev. 2013;30(4):CD005175.

    Google Scholar 

  16. 16.

    Bonn-Miller MO, Oser ML, Bucossi MM, Trafton JA. Cannabis use and HIV antiretroviral therapy adherence and HIV-related symptoms. J Behav Med. 2014;37(1):1–10.

    Article  Google Scholar 

  17. 17.

    Ghosn J, Leruez-Ville M, Blanche J, Delobelle A, Beaudoux C, Mascard L, et al. HIV-1 DNA levels in peripheral blood mononuclear cells and cannabis use are associated with intermittent HIV shedding in semen of men who have sex with men on successful antiretroviral regimens. Clin Infect Dis. 2014;58(12):1763–70.

    CAS  Article  Google Scholar 

  18. 18.

    Rasbach DA, Desruisseau AJ, Kipp AM, Stinnette S, Kheshti A, Shepherd BE, et al. Active cocaine use is associated with lack of HIV-1 virologic suppression independent of nonadherence to antiretroviral therapy: use of a rapid screening tool during routine clinic visits. AIDS Care. 2013;25(1):109–17.

    Article  Google Scholar 

  19. 19.

    Chao C, Jacobson LP, Tashkin D, Martínez-Maza O, Roth MD, Margolick JB, et al. Recreational drug use and T lymphocyte subpopulations in HIV-uninfected and HIV-infected Men. Drug Alcohol Depend. 2008;94(1–3):165–71.

    Article  Google Scholar 

  20. 20.

    Dʼsouza G, Matson PA, Grady CD, Nahvi S, Merenstein D, Weber KM, et al. Medicinal and recreational marijuana use among HIV-infected women in the Women’s Interagency HIV Study (WIHS) cohort, 1994-2010. J Acquir Immune Defic Syndr. 2012;61(5):618–26.

    Article  Google Scholar 

  21. 21.

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

    Article  Google Scholar 

  22. 22.

    Mannes ZL, Burrell LE, Ferguson EG, Zhou Z, Lu H, Somboonwit C, et al. The association of therapeutic versus recreational marijuana use and antiretroviral adherence among adults living with HIV in Florida. Patient Prefer Adherence. 2018;12:1363–72.

    Article  Google Scholar 

  23. 23.

    Koethe JR, Jenkins CA, Turner M, Bebawy S, Shepherd BE, Wester CW, et al. Body mass index and the risk of incident non-communicable diseases after starting antiretroviral therapy. HIV Med. 2015;16(1):67–72.

    CAS  Article  Google Scholar 

  24. 24.

    McGowan CC, Weinstein DD, Samenow CP, Stinnette SE, Barkanic G, Rebeiro PF, et al. Drug use and receipt of highly active antiretroviral therapy among HIV-infected persons in two US clinic cohorts. PLoS ONE. 2011;6(4):e18462.

    CAS  Article  Google Scholar 

  25. 25.

    StataCorp. Stata statistical software. College Station: StataCorp; 2011.

    Google Scholar 

  26. 26.

    Lucas GM, Cheever LW, Chaisson RE, Moore RD. Detrimental effects of continued illicit drug use on the treatment of HIV-1 infection. J Acquir Immune Defic Syndr. 2001;27(3):251–9.

    CAS  Article  Google Scholar 

  27. 27.

    Lucas GM, Griswold M, Gebo KA, Keruly J, Chaisson RE, Moore RD. Illicit drug use and HIV-1 disease progression: a longitudinal study in the era of highly active antiretroviral therapy. Am J Epidemiol. 2006;163(5):412–20.

    Article  Google Scholar 

  28. 28.

    Poundstone KE, Chaisson RE, Moore RD. Differences in HIV disease progression by injection drug use and by sex in the era of highly active antiretroviral therapy. AIDS. 2001;15(9):1115–23.

    CAS  Article  Google Scholar 

  29. 29.

    Samet JH, Cheng DM, Libman H, Nunes DP, Alperen JK, Saitz R. Alcohol consumption and HIV disease progression. J Acquir Immune Defic Syndr. 2007;46(2):194–9.

    Article  Google Scholar 

  30. 30.

    Sethi AK, Celentano DD, Gange SJ, Moore RD, Gallant JE. Association between adherence to antiretroviral therapy and human immunodeficiency virus drug resistance. Clin Infect Dis. 2003;37(8):1112–8.

    Article  Google Scholar 

  31. 31.

    Kipp AM, Rebeiro PF, Shepherd BE, Brinkley-Rubinstein L, Turner M, Bebawy S, et al. Daily marijuana use is associated with missed clinic appointments among HIV-infected persons engaged in HIV care. AIDS Behav. 2017;21(7):1996–2004.

    Article  Google Scholar 

  32. 32.

    Furler MD, Einarson TR, Millson M, Walmsley S, Bendayan R. Medicinal and recreational marijuana use by patients infected with HIV. AIDS Patient Care STDS. 2004;18(4):215–28.

    Article  Google Scholar 

  33. 33.

    Qian H-Z, Mitchell VJ, Bebawy S, Cassell H, Perez G, McGowan CC, et al. Current drug use and lack of HIV virologic suppression: point-of-care urine drug screen versus self-report. BMC Infect Dis. 2014;18(14):508.

    Article  Google Scholar 

  34. 34.

    Solowij N, Stephens RS, Roffman RA, Babor T, Kadden R, Miller M, et al. Cognitive functioning of long-term heavy cannabis users seeking treatment. JAMA. 2002;287(9):1123–31.

    Article  Google Scholar 

  35. 35.

    Bolla KI, Brown K, Eldreth D, Tate K, Cadet JL. Dose-related neurocognitive effects of marijuana use. Neurology. 2002;59(9):1337–43.

    CAS  Article  Google Scholar 

  36. 36.

    Moore THM, Zammit S, Lingford-Hughes A, Barnes TRE, Jones PB, Burke M, et al. Cannabis use and risk of psychotic or affective mental health outcomes: a systematic review. Lancet. 2007;370(9584):319–28.

    Article  Google Scholar 

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This research was supported in part by the National Institutes of Health funded Tennessee Center for AIDS Research (P30 AI110527) and K24 AI065298 (TRS).

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Correspondence to Todd Hulgan.

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Lee, J.T., Saag, L.A., Kipp, A.M. et al. 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 Behav 24, 1275–1280 (2020).

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  • HIV
  • Cannabis
  • Anti-retroviral therapy
  • BMI