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

Abstract

Background: While cannabis use is prevalent among people with HIV (PWH), factors associated with higher-risk use require further study. We examined factors (mental health, sociodemographics, substance use, HIV clinical markers) associated with risk for cannabis use disorder (CUD) among PWH who used cannabis. Methods: 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]), duration of HIV status, 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. Results: Of the complete sample (N = 973; 94.1% Male; 58.5% White; Age Median=54.5), 35.9% reported higher risk for CUD. Unadjusted models indicated age, Black race, higher CCI, depression, anxiety, and higher risk tobacco use were associated with higher risk, while only Black race (OR = 1.90, 95% CI[1.32, 2.72]), anxiety (OR = 1.91, 95% CI[1.22, 2.99]), and higher risk tobacco use (OR = 2.25, 95% CI[1.46, 3.48]) remained significant in the multivariable model. Conclusions: Black race, anxiety and tobacco use were associated with higher risk for CUD among PWH in a multivariable model. Clinical efforts to screen and provide interventions for preventing CUD alongside anxiety and tobacco use among PWH should be evaluated.