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

在艾滋病毒携带者(PLWH)中，日常使用大麻越来越普遍。在佛罗里达州， 仍然是美国艾滋病毒发病率和流行率最高的地区之一，预计选民将 2016年底通过一项修正案，将医用大麻合法化，供PLWH使用。虽然有一些证据表明 尽管大麻可以改善艾滋病毒相关症状，但目前几乎没有证据表明长期服用大麻可以改善艾滋病病毒的相关症状。 大麻对长春市妇女健康的长期影响。大麻，其中含有许多不同的大麻素 产品，可能通过两种行为机制影响艾滋病毒健康结果(例如，药物依从性， 动机)和生物机制(例如抗炎、病毒抑制)。的首要目标是 这项研究旨在获得大麻对主要健康后果和行为的影响的证据。 以帮助指导临床建议和确定后果的风险因素。我们是 尤其对大麻与认知功能的新方面的关系感兴趣(例如，动机， 意图、计划)和全身炎症。为了实现这些研究目标，我们提出了一种新的， 480名长期吸食大麻者(160人经常吸食大麻，160人偶尔吸食大麻，160人不吸食大麻)的纵向队列 用户)。我们将获得详细的大麻评估，包括大麻生物标志物，以及 测量认知、全身炎症、艾滋病毒护理参与度和健康结果。我们的特定 目标是：1)前瞻性地确定日常和偶尔使用大麻与艾滋病毒护理之间的联系 参与、病毒抑制和HIV疾病进展；2)前瞻性地确定 过去和现在的大麻使用与认知功能、动机和计划；以及3)前瞻性 确定慢性吸食大麻与慢性炎症的细胞因子标志物之间的关系。对于每一个 为了达到这些目标，我们将进行分组分析，以探索这些关系是否因个人而异 特征，如性别和年龄(50对50)，以及过去和现在使用大麻的特点， 包括大麻使用障碍。这将是最大的关注健康影响的前瞻性队列研究。 帕洛阿尔托妇女医院的大麻。这一发现将通知艾滋病毒治疗提供者和正在考虑 大麻，以管理艾滋病毒相关症状或艾滋病毒疾病本身，并将查明大麻的使用模式 这与物质使用障碍的发生率最密切相关。我们的研究团队是 多学科，我们的基础设施已经到位，我们的初步数据支持这个项目的需求。这个 研究与目前NIH艾滋病毒研究的优先事项一致，以减少艾滋病毒传播(通过成功 治疗和病毒抑制)，并减少艾滋病毒相关共病的发病，包括认知 功能障碍。

Daily use of marijuana use is increasingly common in persons living with HIV (PLWH). In Florida, which continues to have one of the highest rates of HIV incidence and prevalence in the US, voters are expected to pass an amendment to legalize medical marijuana for use by PLWH in late 2016. While there is some evidence that marijuana can improve HIV-related symptoms, there is almost no existing evidence regarding the long- term health effects of marijuana in PLWH. Marijuana, which contains a number of different cannabinoid products, could affect HIV health outcomes via both behavioral mechanisms (e.g. medication adherence, motivation) and biological mechanisms (e.g. anti-inflammatory, viral suppression). The overarching goals of this study are to obtain evidence regarding the influence of marijuana on major health outcomes and behavior in PLWH in order to help guide clinical recommendations and identify risk factors for consequences. We are especially interested in the relationship of marijuana to novel aspects of cognitive function (e.g. motivation, intention, planning) and to systemic inflammation. To accomplish these research goals, we propose a new, longitudinal cohort of 480 PLWH (160 regular marijuana users, 160 occasional marijuana users, and 160 non- users). We will obtain detailed marijuana assessments, including cannabis biomarkers, together with repeated measures of cognition, systemic inflammation, and HIV care engagement and health outcomes. Our Specific Aims are: 1) To prospectively determine the association of daily and occasional marijuana use with HIV care engagement, viral suppression, and HIV disease progression; 2) to prospectively determine the association of past and current marijuana use with cognitive function, motivation, and planning; and 3) to prospectively determine the association of chronic marijuana use with cytokine markers of chronic inflammation. For each of these aims, we will conduct subgroup analyses to explore whether these relationships vary by individual characteristics such as gender and age (>50 vs. <50), and by characteristics of past and current marijuana use, including cannabis use disorder. This will be the largest prospective cohort study focused on the health effects of marijuana in PLWH. The findings will inform HIV treatment providers and patients who are considering marijuana to manage HIV-related symptoms or HIV disease itself, and will identify patterns of marijuana use that are most strongly associated with the incidence of substance use disorders. Our research team is multidisciplinary, our infrastructure is in place, and our preliminary data support the need for this project. The research is consistent with current NIH HIV research priorities to reduce HIV transmission (by successful treatment and viral suppression) and to reduce the onset of HIV-related comorbidities, including cognitive dysfunction.