Antiretroviral adherence and prescribed cannabis use in a population of people living with HIV/AIDS

Abstract Background: 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 possible 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. In order to identify which PLWHA are accessing prescription cannabis, we also examined prevalence and correlates of those receiving a prescription for cannabis in the past six months. Methods: 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 six 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. Using a cross-sectional design and bivariate statistical methods we also examined the prevalence and correlates of prescribed cannabis. Results: From May 2005 to May 2012, 523 HIV-positive illicit drug users were recruited and contributed 1215 person-years of observation. 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 ART (Adjusted Odds Ratio = 1.12, 95% Confidence Interval [95% CI]: 0.76 – 1.64, p-value = 0.555). From November 2011 to December 2012, 519 HIV-positive illicit drug users were surveyed, and in cross-sectional analysis, 81 (15.6%) individuals reported receiving a prescription for cannabis in the past 6 months. We found no significant differences among those who were and were not prescribed cannabis. Conclusions: High-intensity cannabis use was not associated with adherence to ART. A number of PLWHA report receiving a prescription for cannabis use. These findings suggest cannabis continues to be utilized by PLWHA for medicinal and recreational purposes without compromising effective adherence to ART.Applied Science, Faculty ofNursing, School ofGraduat