Substance use and mental health factors associated with self-reported higher risk cannabis use among people with HIV screened in primary care

BMC Public Health. 2025 Jul 29;25(1):2580. doi: 10.1186/s12889-025-23735-8.

ABSTRACT

BACKGROUND: While cannabis use is prevalent among people with HIV (PWH), factors associated with higher-risk use require further study. We examined factors (mental health, sociodemographics, substance use, HIV clinical markers) associated with risk for cannabis use disorder (CUD) among PWH who used cannabis.

METHODS: Participants included adult (≥ 18 years old) PWH from 3 HIV primary care clinics in Kaiser Permanente Northern California who reported past three-month cannabis use through the computerized Tobacco, Alcohol, Prescription medication, and other Substance use (TAPS) screening. Primary outcome was TAPS cannabis score (range 1-3), categorized as any use (1) and higher risk for CUD (≥ 2). Measures included sociodemographics (age, sex, race, neighborhood deprivation index [NDI]), duration of HIV status, Charlson Comorbidity Index (CCI), HIV RNA, CD4 cell counts, higher risk tobacco use (TAPS tobacco score ≥ 2), depression, and anxiety symptoms. Unadjusted and multivariable logistic regression examined factors associated with higher risk for CUD.

RESULTS: Of the complete sample (N = 973; 94.1% Male; 58.5% White; Age _Median=54.5), 35.9% reported higher risk for CUD. Unadjusted models indicated age, Black race, higher CCI, depression, anxiety, and higher risk tobacco use were associated with higher risk, while only Black race (OR = 1.90, 95% CI[1.32, 2.72]), anxiety (OR = 1.91, 95% CI[1.22, 2.99]), and higher risk tobacco use (OR = 2.25, 95% CI[1.46, 3.48]) remained significant in the multivariable model.

CONCLUSIONS: Black race, anxiety and tobacco use were associated with higher risk for CUD among PWH in a multivariable model. Clinical efforts to screen and provide interventions for preventing CUD alongside anxiety and tobacco use among PWH should be evaluated.

PMID:40730987 | DOI:10.1186/s12889-025-23735-8