Cannabis Use Disorder Among People With and Without HIV

In the United States, adults aged 65 and older are the fastest-growing age group using cannabis. People living with HIV (PLWH) are an aging population with prevalent cannabis use exceeding the general population. We examined cannabis use disorder (CUD) diagnoses from 2000 to 2022, by age, race/ethnicity, sex, comorbidity, and HIV status.

This analysis (2000-2022) includes electronic health records from 185,372 individuals in the Veterans Aging Cohort Study-HIV, a national US cohort of PLWH matched 1:2 to people without HIV (PLWoH). Annual CUD diagnosis was determined by dividing the number with CUD International Classification of Diseases-Clinical Modification codes by total observations. We examined trends by age, race/ethnicity, sex, comorbidity, and HIV status graphically and with multivariable logistic models.

Demographic characteristics were comparable for PLWH (n=58,959) versus PLWoH (n=126,413): 45% Black non-Hispanic (NH); 35% White NH; 7% Hispanic; 3% women, mean age 48 years. Twenty percent of PLWH had a CUD from 2000 to 2022. CUD increased in all subgroups and was consistently higher among PLWH (odds ratio=1.14 [95% CI=1.11-1.18]). Individuals 65 and older experienced the greatest relative increase: PLWH (0.9% vs. 4.0%) and PLWoH (0.03% vs. 3.15%).

CUD increased dramatically among all subgroups over time and was higher among PLWH. CUD increase among older PLWH and those with multimorbidity is especially concerning as cannabis interacts with many prescription medications. Universal screening and treatment advances are needed, as is research characterizing patterns and modalities of cannabis use, CUD, and potential harms and benefits in PLWH and PLWoH.