Regular Marijuana Use is Associated with Poor Viral Suppression in HIV-Infected Adolescents and Young Adults

Understanding African American/Black and Latine young and emerging adults living with HIV: a sequential explanatory mixed methods study focused on self-regulatory resources

BACKGROUND

HIV care continuum engagement is inadequate among African American/Black and Latine (AABL) young/emerging adults living with HIV in the United States. Within this population, some subgroups face barriers to research and are under-studied. Grounded in social action theory, the present study focuses on a diverse community-recruited cohort including those with non-suppressed HIV viral load. Using a sequential explanatory mixed methods design, we describe contextual self-regulatory resources (e.g., substance use, mental health), and their relationships to HIV management.

METHODS

Participants (N = 271) engaged in structured baseline assessments and biomarker testing (HIV viral load, drug screening). Being well-engaged in HIV care and HIV viral suppression were the primary outcomes. We purposively sampled a subset for maximum variability for in-depth interviews (N = 41). Quantitative data were analyzed via descriptive statistics and logistic regression, and results were used to develop qualitative research questions. Then, qualitative data were analyzed via directed content analysis. The joint display method was used to integrate results.

RESULTS

Participants' mean age was 25 years (SD = 2). The majority (59%) were Latine/Hispanic and 41% were African American/Black. Nearly all were assigned male sex at birth (96%) and identified as gay/bisexual/queer (93%). The average HIV diagnosis was 4 years prior (SD = 3). The majority were well-engaged in HIV care (72%) and evidenced viral suppression (81%). Substance use (tobacco, marijuana, alcohol) was prevalent, mainly at low- and moderate-risk levels. Drug screening indicated marijuana, methamphetamine, and MDMA were the most common recent substances. Symptoms of depression and PTSD were associated with decreased odds of engagement in care. High-risk cannabis use was associated with decreased odds of HIV viral suppression. Qualitative results highlighted the prevalence of substance use in social networks and venues, and the importance of substances as a coping strategy, including for mental health distress. Tobacco and methamphetamine (but not marijuana) were described as problematic, and marijuana was used as harm reduction. Substance use was more common among those with non-suppressed versus suppressed HIV viral load. However, overall, substance use did not commonly interfere substantially with HIV management.

CONCLUSIONS

The present study advances knowledge on AABL young/emerging adults living with HIV and highlights ways to improve screening and services.

Impacts of Substance Use and Mental Health Symptoms on Cervical Cancer Screening and Viral Suppression: A Mixed Methods Study With Reproductive-Age Women With HIV in Florida

ABSTRACT

Women with HIV (WWH) often receive suboptimal screening for cervical cancer despite being at an increased risk for cervical cancer and poor viral suppression. Mental health symptoms and substance use can adversely influence cervical cancer screening and viral suppression. The subjective experience of how these variables influence these outcomes in reproductive-age WWH is not well understood. Our study explored the perspectives of reproductive-age WWH living in Florida regarding the mechanisms by which mental health or substance abuse influences cervical cancer screening and viral suppression. An explanatory sequential mixed methods research design was used. A one-on-one semi-structured interview guided and informed by the Social Ecological Model (SEM) and results from previous quantitative analysis were used (N =16). Themes related to how substance use and mental health symptoms as barriers, and facilitators, including motherhood, community support, marijuana use, and medication adherence were reported. Study finding implications for research and clinicians are discussed.

Durable Viral Suppression Among Young Adults Living with HIV Receiving Ryan White Services in New York City

Identifying factors associated with durable viral suppression (DVS) can inform interventions to support young adults living with HIV (YALWH) in sustaining optimal health. We examined associations between client characteristics and DVS among YALWH aged 18-29 who completed an intake assessment and received ≥ 1 Ryan White Part A service in New York City from 1/2017 to 12/2019. Individuals were classified as achieving DVS at least once if they had ≥ 2 suppressed viral load test results ≥ 90 days apart with: (a) no intervening unsuppressed viral load test results in a 12-month period; and (b) no unsuppressed viral load test results after achieving DVS in that 12-month period. Of 2208 YALWH, 92.1% (n = 2034) had sufficient data in the New York City HIV Surveillance Registry to ascertain DVS status. Of these, 68% achieved DVS at least once. Controlling for ART prescription status at intake, YALWH with higher incomes were significantly more likely to achieve DVS at least once. YALWH with lifetime and recent histories of incarceration and/or drug use were significantly less likely to achieve DVS. Our findings underscore the potential role of tailored harm reduction and post-incarceration programs in reducing health inequities among YALWH.

Marijuana Use and Health Outcomes in Persons Living With HIV: Protocol for the Marijuana Associated Planning and Long-term Effects (MAPLE) Longitudinal Cohort Study

BACKGROUND

Marijuana use is common in persons with HIV, but there is limited evidence of its relationship with potential health benefits or harms.

OBJECTIVE

The Marijuana Associated Planning and Long-term Effects (MAPLE) study was designed to evaluate the impact of marijuana use on HIV-related health outcomes, cognitive function, and systemic inflammation.

METHODS

The MAPLE study is a longitudinal cohort study of participants living with HIV who were recruited from 3 locations in Florida and were either current marijuana users or never regular marijuana users. At enrollment, participants completed questionnaires that included detailed marijuana use assessments, underwent interviewer-administered neurocognitive assessments, and provided blood and urine samples. Ongoing follow-ups included brief telephone assessments (every 3 months), detailed questionnaires (annually), repeated blood and urine samples (2 years), and linkage to medical records and statewide HIV surveillance data. Supplemental measures related to intracellular RNA, COVID-19, Alzheimer disease, and the gut microbiome were added after study initiation.

RESULTS

The MAPLE study completed enrollment of 333 persons between 2018 and 2021. The majority of participants in the sample were ≥50 years of age (200/333, 60.1%), male (181/333, 54.4%), cisgender men (173/329, 52.6%), non-Hispanic Black (221/333, 66.4%), and self-reported marijuana users (260/333, 78.1%). Participant follow-up was completed in 2022, with annual updates to HIV surveillance data through at least 2027.

CONCLUSIONS

The MAPLE study is the largest cohort specifically designed to understand the use of marijuana and its effects on HIV-related outcomes. The study population has significant diversity across age, sex, gender, and race. The data will help clinicians and public health officials to better understand patterns of marijuana use associated with both positive and negative health outcomes, and may inform recommendations for future clinical trials related to medical marijuana and HIV.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/37153.

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

In 2017, a National Academies of Sciences, Engineering, and Medicine (NASEM) report comprehensively evaluated the body of evidence regarding cannabis health effects through the year 2016. The objectives of this study are to identify and map the most recently (2016-2019) published literature across approved conditions for medical cannabis and to evaluate the quality of identified recent systematic reviews, published following the NASEM report. Following the literature search from 5 databases and consultation with experts, 11 conditions were identified for evidence compilation and evaluation: amyotrophic lateral sclerosis, autism, cancer, chronic noncancer pain, Crohn's disease, epilepsy, glaucoma, human immunodeficiency virus/AIDS, multiple sclerosis (MS), Parkinson's disease, and posttraumatic stress disorder. A total of 198 studies were included after screening for condition-specific relevance and after imposing the following exclusion criteria: preclinical focus, non-English language, abstracts only, editorials/commentary, case studies/series, and non-U.S. study setting. Data extracted from studies included: study design type, outcome definition, intervention definition, sample size, study setting, and reported effect size. Few completed randomized controlled trials (RCTs) were identified. Studies classified as systematic reviews were graded using the Assessing the Methodological Quality of Systematic Reviews-2 tool to evaluate the quality of evidence. Few high-quality systematic reviews were available for most conditions, with the exceptions of MS (9 of 9 graded moderate/high quality; evidence for 2/9 indicating cannabis improved outcomes; evidence for 7/9 indicating cannabis inconclusive), epilepsy (3 of 4 graded moderate/high quality; 3 indicating cannabis improved outcomes; 1 indicating cannabis inconclusive), and chronic noncancer pain (12 of 13 graded moderate/high quality; evidence for 7/13 indicating cannabis improved outcomes; evidence from 6/7 indicating cannabis inconclusive). Among RCTs, we identified few studies of substantial rigor and quality to contribute to the evidence base. However, there are some conditions for which significant evidence suggests that select dosage forms and routes of administration likely have favorable risk-benefit ratios (i.e., epilepsy and chronic noncancer pain). The body of evidence for medical cannabis requires more rigorous evaluation before consideration as a treatment option for many conditions, and evidence necessary to inform policy and treatment guidelines is currently insufficient for many conditions.

Mental Health Service Utilization Among Young Black Gay, Bisexual, and Other Men Who Have Sex with Men in HIV Care: A Retrospective Cohort Study

Young Black gay, bisexual, and other men who have sex with men (YB-GBMSM) face multiple psychosocial stressors, and are disproportionately impacted by HIV. Mental health care engagement is a promising avenue for addressing these disparities. To date, rates of mental health service utilization have not been examined specifically in this population. We conducted a retrospective cohort study among YB-GBMSM receiving care in a Ryan White-funded HIV care center that includes co-located HIV and mental health services. Of 435 unique YB-GBMSM patients, mental health concerns were identified in n = 191 (43.9%). Depressive symptoms were the most common concerns identified, followed by substance use, anxiety, and trauma. Among patients with identified mental health concerns who were not previously in mental health care, 79.1% were referred to mental health care, 56.3% set an appointment with a mental health provider, 40.5% were linked to mental health care (attended an initial visit), and 19.6% remained engaged in mental health care. Younger YB-GBMSM (age 18-24 years), who received care in a more integrated pediatric/adolescent part of the center, were more likely to have an appointment set once a concern was identified (χ² = 7.17; p = 0.007). Even in a setting with co-located HIV and mental health care services, we found significant gaps in engagement at each stage of a newly described mental health care continuum. Implications for intervention at the provider and systems levels are discussed.

Clinical Data for the Use of Cannabis-Based Treatments: A Comprehensive Review of the Literature

Objective:

To compile and synthesize the available literature describing medical cannabis use across various disease states.

Data Sources:

PubMed, EBSCO, and Google Scholar searches were conducted using MeSH and/or keywords.

Study Selection and Data Extraction:

Studies were included if they described the use of cannabis-based products and medications in the treatment of a predefined list of disease states in humans and were published in English. The extraction period had no historical limit and spanned through April 2019.

Data Synthesis:

Evidence was compiled and summarized for the following medical conditions: Alzheimer disease, amyotrophic lateral sclerosis, autism, cancer and cancer-associated adverse effects, seizure disorders, human immunodeficiency virus, inflammatory bowel disease, multiple sclerosis (MS), nausea, pain, posttraumatic stress disorder, and hospice care.

Relevance to Patient Care and Clinical Practice:

Based on identified data, the most robust evidence suggests that medical cannabis may be effective in the treatment of chemotherapy-induced nausea and vomiting, seizure disorders, MS-related spasticity, and pain (excluding diabetic neuropathy). Overall, the evidence is inconsistent and generally limited by poor quality. The large variation in cannabis-based products evaluated in studies limits the ability to make direct comparisons. Regardless of the product, a gradual dose titration was utilized in most studies. Cannabis-based therapies were typically well tolerated, with the most common adverse effects being dizziness, somnolence, dry mouth, nausea, and euphoria.

Conclusions:

As more states authorize medical cannabis use, there is an increasing need for high-quality clinical evidence describing its efficacy and safety. This review is intended to serve as a reference for clinicians, so that the risks and realistic benefits of medical cannabis are better understood.