Marijuana as a Modifiable Cardiovascular Risk Factor in People Living With HIV

The literature offers conflicting data on the effects of marijuana on HIV disease progression, CD4 count, and HIV viral load. People living with HIV have a 2-fold increase in cardiovascular disease compared with age-matched HIV-uninfected controls, which is only partially explained by the presence of traditional cardiovascular risk factors, antiretroviral therapy effect, and healthcare disparities. This 20-year prospective cohort study of 558 men living with HIV examined the associations between heavy marijuana use and HIV disease markers and health outcomes, including cardiovascular endpoints.

• The median baseline age of participants was 41 years; 66% were white; and 70% had >12 years of education. At >50% of the biannual follow up visits, 20% of participants reported daily or weekly marijuana use (defined as “heavy use”).
• There was no association between heavy marijuana use and HIV disease markers.
• There were no associations between heavy marijuana use and progression to AIDS, cancer diagnosis, or mortality.
• Heavy marijuana use was associated with increased cardiovascular events between the ages of 40 and 60 (odds ratio, 2.5) after adjusting for age, tobacco smoking, HIV viral load, and traditional cardiovascular risk factors.

Comments: Although these results should be replicated in other cohorts, heavy marijuana use may be a modifiable cardiovascular risk factor among people living with HIV and should be discussed as part of routine preventive care.

Jeanette M. Tetrault, MD

Reference: Lorenz DR, Dutta A, Mukerji SS, et al. Marijuana use impacts midlife cardiovascular events in HIV-infected men. Clin Infect Dis. 2017;65(4):626–635.