Effect of Marijuana Smoking on Pulmonary Disease in HIV-Infected and Uninfected Men: A Longitudinal Cohort Study

Abstract

Summary Background Lung disease is a common comorbidity in people with HIV/AIDS, independent of smoking status. The effects of marijuana smoking on risk of lung disease in HIV-infected individuals are unclear. Methods In this prospective cohort study, we quantified lung disease risk among men enrolled in the Multicenter AIDS Cohort Study (MACS), a long-term observational cohort of HIV-infected and uninfected men who have sex with men. Eligible participants were aged ≥ 30 years with self-reported marijuana and tobacco smoking data from biannual study visits between 1996 and 2014. Pulmonary diagnoses were obtained from self-report and medical records. Analyses were performed using Cox models and Generalized Estimating Equations adjusted for tobacco smoking, CD4 T cell count, and other risk factors. Findings 1630 incident pulmonary diagnoses were reported among 1352 HIV-seropositive and 1352 HIV-seronegative eligible participants matched for race and baseline age (53,794 total person-visits, median follow-up 10.5 years). 27% of HIV-infected participants reported daily or weekly marijuana smoking for one or more years in follow-up, compared to 18% of uninfected participants (median 4·0 and 4·5 years daily/weekly use, respectively). HIV-infected participants had an increased likelihood of infectious or non-infectious pulmonary diagnoses compared to uninfected participants (33·2% vs. 21·5%, and 20·6% vs. 17·2%, respectively). Among HIV-infected participants, recent marijuana smoking was associated with increased risk of infectious pulmonary diagnoses and chronic bronchitis independent of tobacco smoking and other risk factors for lung disease (hazard ratio [95% confidence interval] 1·43 [1·09–1·86], and 1·54 [1·11–2·13], respectively); these risks were additive in participants smoking both substances. There was no association between marijuana smoking and pulmonary diagnoses in HIV-uninfected participants. Interpretation In this longitudinal study, long-term marijuana smoking was associated with lung disease independent of tobacco smoking and other risk factors in HIV-infected individuals. These findings could be used to reduce modifiable risks of lung disease in high-risk populations. Funding U.S. .

Transcriptomic analysis of monocytes from HIV-positive men on antiretroviral therapy reveals effects of tobacco smoking on interferon and stress response systems associated with depressive symptoms

“…However, we detected a set of common smoking-associated genes typically differentially expressed with low fold-changes in monocytes reported in previous studies [14–16, 21]. Previous studies collecting detailed smoking exposure data during the same calendar period in large MACS cohorts reported comparable proportions of current smokers among HIV+ participants (20–30%), with roughly twice as many heavy (≥ 1/2 packs/day) compared with light smokers (> 0–< 1/2 packs/day) [7]. Therefore, most tobacco smokers in this study were likely to be heavy smokers.…”

“…All HIV+ participants were on ART at the time of sample collection, but detailed medication data was available for only 21 participants (38% on NNRTI-based regimens, 48% PI-based regimens, 10% PI + NNRTI-based regimens, 5% INSTI-based regimens); regimens did not differ by tobacco smoking or marijuana use ( p = 0.557 and p = 0.730, respectively; Fisher’s exact test). Our recent study of tobacco and marijuana smokers in a large cohort from the MACS [7] found similar proportions of regimens from 988 participants during the same 2011–2015 calendar period (42% on NNRTI-based regimens, 32% PI-based regimens, 4% PI + NNRTI-based regimens, 20% INSTI-based regimens) and no difference in regimens between tobacco or marijuana smokers ( p = 0.165 and p = 0.577, respectively; Fisher’s exact test). Therefore, ART regimens were likely to be similar in participants with missing data, and that differences in ART medications did not substantially affect gene expression differences by smoking.…”

“…Estimates of the proportion of current smokers among HIV+ adults in the USA range from 33–42%, approximately twice as high as in the general population, and HIV+ individuals are less likely to quit smoking [3, 4]. Furthermore, HIV+ individuals have higher rates of comorbidities associated with smoking compared with persons in the general population, including lung cancer [5], infectious and chronic obstructive pulmonary diseases (COPD) [6, 7], and cardiovascular disease [8–10].…”

Periodontal Conditions and Whole Salivary IL-17A and -23 Levels among Young Adult Cannabis sativa (Marijuana)-Smokers, Heavy Cigarette-Smokers and Non-Smokers

“…Self-reported heavy smokers (individuals who had at least 40 pack-years of smoking) [ 23 , 24 ]; marijuana-smokers (individuals who were daily smoking marijuana for at least 1 year) [ 25 ]; and non-smokers (individuals that reported to have never used any form of tobacco-product and/or recreational drug) were included [ 13 , 26 ]. Self-reported dual-smokers (individuals smoking cigarettes as well as marijuana), light and moderate smokers, patients with systemic diseases such as HIV+ individuals and patients with cardiovascular, hepatic, endocrine and/or renal diseases were excluded.…”

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

“…In the first longitudinal study to address the relationship between marijuana use and pulmonary disease in HIV‐infected men, Lorenz et al . [10] found that daily or weekly marijuana smoking was associated with increased risk of infectious pulmonary diagnoses and self‐reported bronchitis after adjusting for tobacco smoking and other relevant risk factors. These observations persisted when analysis was restricted to subjects with normal CD4 counts, suggesting that differences in host characteristics beyond immunodeficiency alone may mediate differential risk of pulmonary complications from marijuana in PLWH.…”