Consider cannabis use when assessing middle-aged and older patients with HIV, say US investigators

Recent cannabis (marijuana) use by middle-aged HIV-positive adults is associated with poor mental health quality of life, lack of social engagement and under- and unemployment, investigators from the United States report in the June 1^st edition of the Journal of Acquired Immune Deficiency Syndromes.

The cross-sectional (snap-shot) design of the study meant that the authors were unable to say for certain if use of cannabis was the cause or just a symptom of these problems. “We are unable to determine whether the association between RMU [recent marijuana use] and lower QOL [quality of life] is the result of lower social functioning choosing to use or self-medicate with marijuana, whether the use of marijuana leads to lower social functioning, or both,” explain the investigators. Nevertheless, they believe their findings have implications for the care of older people living with HIV and that those reporting use of cannabis should have mental health and social support assessments.

With the right treatment and care, people with HIV can have an excellent life expectancy. Prevention and management of diseases and conditions associated with ageing are therefore increasingly important components of HIV care. 

The authors of the current study believe that an aim of this care should be the promotion of “successful ageing”, which they define as the absence of disease, a high level of physical function, good mental and emotional health and high levels of social engagement.

Research examining the use of cannabis by people with HIV has typically focused on its use as palliative therapy for the relief of symptoms associated with HIV infection or treatment with antiretroviral drugs. Most of these studies were conducted before or soon after effective HIV therapy became available.

Medicinal use of cannabis was legalised in the US state of Colorado in 2000. Investigators from the University of Colorado wished to determine the impact of cannabis use by middle-aged people with HIV (45 to 65 years) on disease burden, physical and mental functioning and quality of life and social engagement.

Recruitment started in late 2010 and the study population comprised 359 people with a median age of 52 years. All were taking antiretroviral treatment and had a suppressed viral load. Median CD4 count was over 500 cells/mm³. The majority of participants in the study were male (85%) and white (75%).

Recent cannabis use was reported by 26% of participants. Use of the drug was associated with longer duration since HIV diagnosis (14 vs 11 years; p = 0.04), increased odds of having a low annual income (92% vs 80%; p = 0.006) and smoking (48% vs 29%; p = 0.001).

After adjusting for potential confounders, there was no difference in the burden of disease reported by users and non-users of cannabis. Nor did physical function differ according to use of the drug, though preliminary analysis suggested cannabis users were less likely to complete a 400-metre walk test.

Cannabis users had lower mental health-related quality of life (role-function, p = 0.05) and social functioning (p = 0.048). Moreover, people reporting recent use of cannabis were also more likely than non-users to be under-employed or unemployed (p = 0.001).

“Among middle-aged HIV-infected persons on effective ART, the impact of RMU on successful aging is associated with selected measures of both physical and mental QOL,” conclude the authors. “Self-reported marijuana use could be used as a ‘red flag’ for a need to evaluate the mental health and social resources for the older adult with HIV…considering marijuana use when identifying potential barriers to successful aging, such as utilization of social resources and support may improve successful aging among older adults with HIV infection.”