Associations of marijuana with markers of chronic lung disease in people living with HIV

Abstract

ObjectivesThe relationship between marijuana use and markers of chronic lung disease in people living with HIV (PLWH) is poorly understood.MethodsWe performed a cross‐sectional analysis of the Examinations of HIV‐Associated Lung Emphysema (EXHALE) study, including 162 HIV‐positive patients and 138 participants without HIV. We modelled marijuana exposure as: (i) current daily or weekly marijuana smoking vs. monthly or less often; or (ii) cumulative marijuana smoking (joint‐years). Linear and logistic regression estimated associations between marijuana exposure and markers of lung disease, adjusted for tobacco smoking and other factors.ResultsIn PLWH, current daily or weekly marijuana use was associated with a larger forced vital capacity (FVC), larger total lung capacity and increased odds of radiographic emphysema compared with marijuana non‐smokers in adjusted models; these associations were not statistically significant in participants without HIV. Marijuana joint‐years were associated with higher forced expiratory volume in 1 s and FVC in PLWH but not with emphysema.ConclusionsIn PLWH, marijuana smoking was associated with higher lung volumes and potentially with radiographic emphysema. No consistently negative associations were observed between marijuana and measures of chronic lung health.

Prevalence of emphysema in people living with human immunodeficiency virus in the current combined antiretroviral therapy era: A systematic review

“…There was a cART coverage of 70–93%, 59–64% were smokers, and 31–33% had a history of intravenous drug use (IVDU). In four of the studies 62–70% of participants had undetectable viral replication ( 6 , 12 , 16 , 27 ). The last two reported viral suppression <400 ml/copies in 80 and 83% of participants, respectively ( 5 , 18 ).…”

“…The studies were mainly published in 2014 or later, except for one study published in 2000. Nine studies were conducted in the US ( 5 , 6 , 11 , 12 , 16 – 20 ), four in Italy ( 21 – 24 ), one in France ( 7 ), one in Denmark ( 4 ), one in Canada ( 25 ), and one in Spain ( 26 ).…”

“…In six studies, the participants were enrolled in the EXHALE study, which was a sub-study of the US Veterans Aging Cohort (VACS) ( 5 , 6 , 12 , 16 , 18 , 27 ). All participants in EXHALE were former soldiers/veterans, and the study included both PLWH and controls.…”

“…Most studies applied a semi-quantitative definition of emphysema by visual assessment of a CT scan ( 5 , 6 , 11 , 12 , 16 , 18 – 25 ). In the studies from the EXHALE cohort, the degree of emphysema was characterized by a thoracic radiologist.…”

“…In the studies from the EXHALE cohort, the degree of emphysema was characterized by a thoracic radiologist. Participants were scored from 0 (no emphysema) to 5 (>75% emphysema), followed by a dichotomization: Trace or no emphysema (≤10%) and mild or greater emphysema (>10%) ( 5 , 6 , 12 , 16 , 18 , 27 ). In the four studies from the Modena cohort, three radiologists gave scores from 0 to 6 to each lobe and divided emphysematous changes by severity: 0 (absence of emphysema) to >4 (severe emphysema).…”