Background
While marijuana use is prevalent among persons with HIV (PWH), few studies have examined the relationship between marijuana use and HIV treatment outcomes independent of alcohol and other drug use.
Methods
We conducted a prospective cohort study to examine the relationships between frequency of marijuana use and antiretroviral therapy (ART) adherence and viral suppression in patients enrolled in the Johns Hopkins HIV Clinical Cohort between September 2013 through November 2015 (N=1377). We categorized marijuana use as no use, none in the last 3 months, monthly use or less, weekly/daily. Our outcomes of interest were use of ART, ≥90 ART adherence, and viral suppression (HIV1-RNA <200 copies). We conducted multivariable analyses to examine associations between the frequency of marijuana use and our treatment outcomes, using generalized estimating equations to account for repeated measures. Other independent variables of interest included alcohol use, other drug use, and depressive symptoms. Analyses were adjusted for age, race, sex and HIV acquisition risk factor.
Results
In multivariable analyses we found no statistically significant association between frequency of marijuana use and our treatment outcomes. Alcohol use, other drug use and depressive symptoms were associated with lower odds of ART adherence and viral suppression.
Conclusions
In this sample of PWH in care, frequency of marijuana use independent of other substance use does not appear to be associated with negative HIV treatment outcomes. Our results indicate that unlike alcohol, other substances and depression, marijuana use may not be a barrier to the effective treatment of HIV.
Several studies have reported the incidence and prevalence of retropubic tension-free vaginal mesh tape (TVT) slingrelated complications, but there are no specific current guidelines regarding the surgical management of such complications. Complications requiring sling removal, such as pain, can be surgically managed by using either a vaginal approach, removing the vaginal portion of the sling up to the pubocervical fascia, and/or a laparoscopic/abdominal approach to the space of Retzius to remove the retropubic portion of the sling. We report a case of a patient with a retropubic TVT sling in whom the removal of the vaginal portion of the sling failed to resolve the patient's symptoms of pain; therefore, a laparoscopic approach to the retropubic space was performed to extract the remaining limbs of the sling.
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