title: 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.
authors.affiliation: BC Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, V6Z 1Y6, BC, Canada.
authors.forename: Gregory
authors.initials: G
authors.lastname: Slawson
authors.forename: M-J
authors.initials: MJ
authors.lastname: Milloy
authors.forename: Lynda
authors.initials: L
authors.lastname: Balneaves
authors.forename: Annick
authors.initials: A
authors.lastname: Simo
authors.forename: Silvia
authors.initials: S
authors.lastname: Guillemi
authors.forename: Robert
authors.initials: R
authors.lastname: Hogg
authors.forename: Julio
authors.initials: J
authors.lastname: Montaner
authors.forename: Evan
authors.initials: E
authors.lastname: Wood
authors.forename: Thomas
authors.initials: T
authors.lastname: Kerr
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D002170:Canada / Q000453:epidemiology; D015331:Cohort Studies; D055030:Drug Users / Q000523:psychology*; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000523:psychology; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008385:Marijuana Smoking / Q000523:psychology*; D064086:Medical Marijuana / Q000627:therapeutic use*; D055118:Medication Adherence / Q000523:psychology*; D008875:Middle Aged; D011795:Surveys and Questionnaires; D016903:Drug Monitoring
chemical_list: D019380:Anti-HIV Agents; D064086:Medical Marijuana