Health outcomes and cognitive effects of marijuana use among persons living with HIV/AIDS

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Abstract Persons living with HIV (PLWH) are an especially vulnerable population in the COVID-19 pandemic given their compromised immune system and comorbidities (e.g., substance use, mental health issues). Currently, no research has examined how the broad impacts of COVID-19 (e.g., extended social isolation, anxiety, family loss) are affecting marijuana use, cannabis use disorder (CUD), and care engagement in PLWH. Further, research has not clarified whether chronic marijuana use will interact with HIV infection to impact the onset and progression of COVID-19 infection. This urgent supplement will allow us to capture this window of opportunity and collect timely data to address these gaps. Our ongoing R01 study of a PLWH cohort focusing on marijuana use provides many unique strengths to support this supplement. The primary goal of the active R01 project is to examine the long-term impact of marijuana use on cognitive functioning and health outcomes in a cohort of PLWH (currently 300 participants completed baseline assessment) in Florida. This supplement is within the scope of the parent grant but extends the parent study by incorporating COVID-19-related questions/measures into the ongoing data collection. We will collect additional data using a mixed method approach which includes quantitative survey questions and in-depth qualitative interviews on a selected subsample. We will conduct COVID-19 antibody tests using the blood sample we collect as a part of the parent grant procedures. We will also link the collected data with the Florida Department of Health EHARS data on HIV-related outcomes (e.g., viral load) over time, which is also a part of the parent study. The specific aims of this supplement include: 1) To identify the impact of the COVID-19 pandemic on changes in marijuana use and cannabis use disorder (CUD) among PLWH; 2) To determine the impact of the COVID-19 pandemic on the HIV care continuum (i.e., HIV care engagement) and outcomes (i.e., viral load); and 3) To estimate the prevalence of COVID-19 infection in our study sample after September 2020, using antibody testing for IgG and IgM. If we have a large enough sample (i.e., 10% tested positive for COVID-19), we will examine the association between marijuana use status and COVID-19 incidence/severity. This study will be the first to address the impacts of the COVID-19 pandemic among an ongoing cohort of PLWH with a focus on marijuana use and its related health outcomes. By collecting additional COVID-19-related information as a part of the regular follow-ups in the parent study, we will be able to provide valuable evidence on how the COVID-19 pandemic may cause changes in PLWH’s marijuana use/CUD and HIV care/outcomes and will be able to identify the underlying mechanism of these changes. Results from the antibody tests may also provide informative data on whether marijuana use interacts with HIV in affecting COVID-19 incidence and severity, which can potentially inform future prevention and treatment programs for COVID-19 in this population.