Impact of Marijuana Use on HIV Treatment Adherence

Marcel Bonn-Miller, Palo Alto Institute for Research & Education
Clinical Sciences
Innovative, Developmental, Exploratory Award (IDEA)

Treatments for HIV, primarily rooted in the delivery of antiretroviral medication, have progressively improved. If taken correctly these significantly extend the lives and reduce the mortality of individuals with HIV, transforming HIV into a chronic illness. Research indicates that medication adherence of at least 95% is required to achieve HIV viral suppression, lower hospitalization, as well as decreased infection. Poor adherence has been associated with medication resistance, increased HIV viral load, risk of developing AIDS, and mortality. Unfortunately, studies that have assessed adherence levels among individuals with HIV have found that between 14% and 35% of individuals with HIV have trouble maintaining at least 80% adherence. Medication side effects (e.g., nausea), regimen complexity (e.g., number of pills), and emotional factors (e.g., anxiety, depression) have been identified as primary contributors to poor medication adherence among individuals with HIV.

Studies examining rates of marijuana use among individuals with HIV suggest that between 23% and 56% of HIV positive individuals have used marijuana in the past month. Approximately 25% - 33% of individuals with HIV report using marijuana to alleviate HIV-related symptoms and medication side effects, which might improve antiretroviral adherence. On the other hand, more severe forms of marijuana use have been associated with increases in anxiety and depressive symptoms, impulsivity, drug use motivation grounded in negative affect reduction, withdrawal symptoms and craving, as well as decreases in cognitive functioning and the ability to tolerate distress. These factors are likely to lead to decreased medication adherence. There is a lack of research focused expressly on the identification of positive and negative factors associated with both the use and non-use of marijuana, including their contribution to differences in antiretroviral treatment adherence. The present proposal will examine associations between marijuana use patterns and antiretroviral adherence, as well as potential meditational factors underlying these associations, in a cross-sectional sample of 180 patients with HIV. This information will guide development of specialized treatment strategies to improve antiretroviral adherence and provide pilot data for future prospective and intervention studies. It will also provide guidance to clinicians in states with medical marijuana laws regarding the clinical implications of marijuana use in HIV patients.