Cannabis use complicates smoking cessation and HIV treatment in key populations

This study examined cannabis co-use among people with HIV (PWH) who smoke cigarettes and are trying to quit. Among 512 participants enrolled in a smoking cessation trial, 28% reported using cannabis in the past 30 days. Researchers found that cannabis co-users were significantly more likely to be younger, Black, and identify as lesbian, gay, or bisexual. Importantly, co-users demonstrated higher rates of missed antiretroviral therapy (ART) doses (53% vs. 37%) and more frequently reported experiencing loss of appetite or taste changes—side effects that could further impact medication adherence and overall health outcomes.

Beyond medication adherence challenges, cannabis co-users experienced a constellation of behavioral and psychosocial risk factors that complicate both smoking cessation and HIV management. These included higher rates of other substance use, financial strain, loneliness, discrimination, and frequent blunt use combined with same-occasion cannabis and tobacco smoking. While co-users paradoxically reported better perceived general health, the data suggests this may reflect cognitive bias rather than actual health status, given their elevated health risks and behavioral challenges.

The findings underscore a critical gap in smoking cessation research and HIV care: cannabis co-use is common but rarely measured in clinical trials, yet it appears to undermine treatment success through multiple pathways—compromising medication adherence, compounding psychosocial stressors, and facilitating continued tobacco use through combined consumption patterns. These results suggest that effective smoking cessation and HIV management programs need to specifically address cannabis use and its intersection with other substance use, particularly among sexual and gender minority communities and Black populations.