The Association Between Marijuana Use and HIV Continuum of Care Outcomes: a Systematic Review

Abstract

Purpose of Review Approximately 77% of HIV-infected adults report lifetime marijuana use. Given the high rates and social acceptability of marijuana use among HIV-infected individuals, it is important to gain a stronger understanding of if, and how, marijuana impacts HIV care cascade outcomes. The purpose of this study is to systematically review recent articles that assess the relationship between marijuana use and HIV continuum of care outcomes. Recent Findings One hundred and ninety articles from PubMed were considered for inclusion, and 15 were included in the review. The studies focus on marijuana use among HIV-infected individuals aware of their serostatus (k = 4), individuals engaged in treatment (k = 1), marijuana use in association with adherence to antiretroviral medications (k = 6), and marijuana use in relation to multiple stages of the HIV care cascade (k = 4). Preliminary findings from the small number of studies revealed an association between marijuana use, especially current heavy use, and HIV seropositivity. However, results from studies assessing marijuana use and treatment engagement and adherence to antiretroviral medications were inconsistent and inconclusive. Summary Additional research is needed to assess the nuanced relationship between marijuana use and HIV continuum of care outcomes, especially among subgroups of HIV-infected individuals, such as men who have sex with men and young adults.

Yes to Recreational Drugs and Complementary Medicines But No to Life-Saving Medications: Beliefs Underpinning Treatment Decisions Among PLHIV

“…While some expressed concerns regarding the negative impact of RD, none made mention of concerns regarding the potential for RD to interact with their prescribed ART. With mounting evidence demonstrating that concurrent RD and ART may result in a range of negative consequences (20,28,32,35,36,38,40), initiatives to improve outcomes for PLHIV must address the unmet needs that drive them to engage in recreational drug use. For many, these needs are related to mental health issues, for which they appear to use RD to self-medicate.…”

“…A large body of evidence confirms the wide-ranging negative impacts of non-adherence [40,[43][44][45][46][47][48]. Other studies have demonstrated that RD use is associated with poor social, mental and financial health [33,34,38,40,42]. CM are also known as 'traditional' or 'alternative' medicines and include substances such as vitamins, minerals, herbal remedies, aromatic oils and homeopathic products [49].…”

“…As explained by Daskalopoulou et al, [28] the main mechanism of drug interaction occurs through the action of RD on the hepatic cytochrome p450 complex of enzymes, the nature and extent of which are yet to be fully understood. Even in the absence of potential RD-ART interactions, the negative consequences of RD use among PLHIV have been well documented [33][34][35][37][38][39][40][41][42]. For example, in their meta-analysis of contemporary research,…”

A Mapping Literature Review of Medical Cannabis Clinical Outcomes and Quality of Evidence in Approved Conditions in the USA from 2016 to 2019

“…Among the 2 studies that investigated symptom mitigation, one indicated an improvement [120] and one was inconclusive [115]. Among the 5 studies examining the effect of cannabis use on adherence to antiretroviral therapy, 2 indicated worsening [171,172], 2 reported no change [160,173], and 1 reported inconclusive findings [174]. One study examining the effect on viral suppression indicated no change [173], and 1 study indicated inconclusive findings [174].…”

Premature Deaths of Young Black Males in the United States

“…The lack of acknowledgment of these structural factors further masks other determinants of premature death impacting the low life expectancy of young Black males. Their troubling educational underachievement, poverty, unemployment, HIV/AIDS, cardiovascular disease, prediabetes, obesity, and smoking (e.g., cigarettes and marijuana) have been found to be factorial threats to their health and lead to premature deaths (Hazekamp et al, 2018; Jones-Eversley & Ravenell, 2018; Montgomery et al, 2019; Pathak, 2018).…”