Substance use and mental health factors associated with self-reported higher risk cannabis use among people with HIV screened in primary care

TL;DR

This study finds that Black race, anxiety, and tobacco use are linked to higher risk of cannabis use disorder among people with HIV, while HIV-related health markers are not.

Contribution

Identifies sociodemographic and mental health factors associated with higher-risk cannabis use in people with HIV.

Findings

35.8% of participants reported higher risk for cannabis use disorder.

Black race, anxiety, and higher-risk tobacco use were significantly associated with higher risk for cannabis use disorder.

HIV clinical markers like CD4 counts and viral load were not significantly linked to cannabis use disorder risk.

Abstract

While cannabis use is prevalent among people with HIV (PWH), factors associated with higher-risk use require further study. We examined factors associated with indicators risk for cannabis use disorder (CUD) among PWH who used cannabis.

Participants included adult (≥18 years old) PWH from 3 HIV primary care clinics in Kaiser Permanente Northern California who reported past three-month cannabis use through the computerized Tobacco, Alcohol, Prescription medication, and other Substance use (TAPS) screening. Primary outcome was TAPS cannabis score (range 1–3), categorized as any use (1) and higher risk for CUD (≥2). Measures included sociodemographics (age, sex, race, neighborhood deprivation index [NDI]), Charlson Comorbidity Index (CCI), HIV RNA, CD4 cell counts, higher risk tobacco use (TAPS tobacco score≥2), depression, and anxiety symptoms. Unadjusted and multivariable logistic regression examined factors associated with higher risk for CUD.

Of the complete sample (N=978; 94.1% Male; 58.3% White; Age Mode=51–60), 35.8% reported higher risk for CUD. Unadjusted models indicated younger age, Black race, higher CCI, depression, anxiety, and higher risk tobacco use were associated with higher risk, while only Black race (OR=1.84, 95% CI[1.29, 2.63]), anxiety (OR=1.91, 95% CI[1.22, 2.98]), and higher risk tobacco use (OR=2.27, 95% CI[1.47, 3.51]) remained significant in the multivariable model.

Black race, anxiety and tobacco use, but not HIV clinical markers, were associated with higher risk for CUD among PWH. Clinical efforts to screen and provide interventions for preventing CUD alongside anxiety and tobacco use among PWH should be evaluated.