Routine male pot smokers with HIV have higher CVD risk

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Middle-aged men living with HIV who smoke pot routinely have an increased risk of cardiovascular disease compared with their peers, says a report on the Poz site. This association is independent of tobacco smoking.

Living with HIV is associated with an increased risk of cardiovascular disease. Additionally, tobacco smoking in particular can increase the overall risk of death dramatically among HIV-positive individuals.

The report says researchers from the Dana-Farber Cancer Institute, Brigham and Women’s Hospital and Massachusetts General Hospital, studied data on 558 HIV-positive men in the Multicentre AIDS Cohort study who enrolled between 1990 and 2010. A total of 376 of them were on antiretrovirals and had a fully suppressed viral load upon entering the study and the remainder tested positive for HIV during the study. The men made twice-yearly visits to the study.

The median age of the participants upon entry into the study was 41 – 66% were white, and 79% had more than a high school education.

The researchers found that 20% of the study participants reported heavy marijuana use – defined as smoking daily or weekly – at 50% or more of their follow-up visits.

After adjusting the data for age, tobacco smoking, viral load and traditional cardiovascular disease risk factors, the researchers found that heavy pot smoking was associated with a 2.5-fold increased risk of heart disease for men 40 to 60 years old.

The study authors also found that both tobacco and marijuana smoking were independently linked with high white blood cell counts. The men in the top quarter for white blood cell counts among the overall group – specifically, a count of at least 6,500 – had a 4.3-fold increased risk of cardiovascular-disease-related health events.

Background: Marijuana use is prevalent among persons infected with HIV, but its long-term effects on HIV disease progression and comorbidities are unknown.
Methods: A prospective study of 558 HIV-infected men enrolled in the Multicenter AIDS Cohort Study between 1990-2010: 182 HIV seroconverters and 376 with viral suppression on combination antiretroviral therapy (ART). Associations between heavy marijuana use and HIV disease markers or white blood cell (WBC) count were examined using mixed-effects and linear regression models. Effects of marijuana use on cardiovascular (CV) events and other endpoints were estimated by Kaplan-Meier and logistic regression analyses.
Results: The median baseline age of participants was 41, 66% were white, 79% had education > 12 years, and 20% reported heavy marijuana use at ≥ 50% of biannual visits during follow-up. Long-term heavy marijuana use showed no significant associations with viral load, CD4 counts, AIDS, cancer, or mortality in both cohorts, but was independently associated with increased CV events between ages 40-60 after adjusting for age, tobacco smoking, viral load, and traditional risk factors (odds ratio [OR], 2.5; 95% confidence interval [CI] 1.3, 5.1). Marijuana and tobacco use were each independently associated with higher WBC counts in adjusted models (P<0.01); in turn, the highest quartile of WBC counts (≥ 6500 cells/µL) was associated with increased CV events (OR 4.3; 95% CI, 1.5, 12.9).
Conclusions: Heavy marijuana use is a risk factor for CV disease in HIV-infected men ages 40-60, independent of tobacco smoking and traditional risk factors.

David R Lorenz, Anupriya Dutta, Shibani S Mukerji, Alex Holman, Hajime Uno, Dana Gabuzda

Poz material
Clinical Infectious Diseases abstract

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