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

吸食大麻对艾滋病毒/艾滋病患者的健康结果和认知影响

• 批准号: 9893854
• 负责人: Robert L Cook
• 金额: $ 63.6万
• 依托单位: UNIVERSITY OF FLORIDA
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-08-15 至 2022-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9893854
• 关键词: AIDS/HIV problem; Acute; Adherence; Affect; Age; Amendment; Anti-Inflammatory Agents; Behavior; Behavioral; Behavioral Mechanisms; Biological; Biological Markers; CD4 Lymphocyte Count; Cannabinoids; Cannabis; Caring; Characteristics; Chronic; Clinical; Clinical Management; Cognition; Cognitive; Cognitive deficits; Cohort Studies; Community Health; Data; Disease; Disease Progression; Florida; Gender; Goals; HIV; HIV Infections; Health; Health Personnel; Health Policy; Healthcare; Impaired cognition; Incidence; Individual; Inflammation; Infrastructure; Intention; Interdisciplinary Study; Intoxication; Legal; Long-Term Effects; Longitudinal cohort; Longitudinal cohort study; Marijuana; Measures; Mediating; Medical Marijuana; Memory; Monitor; Motivation; Outcome; Patients; Pattern; Persons; Prevalence; Prospective cohort study; Public Health; Publishing; Recommendation; Recording of previous events; Research; Research Infrastructure; Research Priority; Risk Factors; Sampling; Subgroup; Substance Use Disorder; Symptoms; Time; United States National Institutes of Health; Urine; Viral; Viremia; cognitive function; cohort; comorbidity; comorbidity Index; cytokine; follow-up; improved; interest; marijuana legalization; marijuana use; marijuana use disorder; marijuana user; medication compliance; multidisciplinary; novel; prospective; prospective memory; recruit; secondary analysis; transmission process

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.

日常吸食大麻在艾滋病毒感染者（PLWH）中越来越普遍。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国家之一，预计选民将 2016 年底通过一项修正案，使 PLWH 使用医用大麻合法化。虽然有一些证据 尽管大麻可以改善与艾滋病毒相关的症状，但几乎没有证据表明大麻可以长期 大麻对 PLWH 的长期健康影响。大麻，含有多种不同的大麻素 产品可能通过两种行为机制（例如药物依从性、 动机）和生物学机制（例如抗炎、病毒抑制）。的总体目标 这项研究旨在获取有关大麻对主要健康结果和行为影响的证据 帮助指导临床建议并确定造成后果的风险因素。我们是 对大麻与认知功能新方面的关系特别感兴趣（例如动机、 意图、计划）和全身炎症。为了实现这些研究目标，我们提出了一个新的、 480 名 PLWH 的纵向队列（160 名经常吸食大麻的人，160 名偶尔吸食大麻的人，以及 160 名非吸食大麻的人） 用户）。我们将获得详细的大麻评估，包括大麻生物标志物，以及重复的 认知、全身炎症、艾滋病毒护理参与度和健康结果的测量。我们的具体 目的是： 1) 前瞻性地确定日常和偶尔吸食大麻与艾滋病毒护理之间的关系 参与、病毒抑制和艾滋病毒疾病进展； 2）前瞻性地确定关联 过去和现在的大麻使用与认知功能、动机和计划； 3) 前瞻性地 确定长期使用大麻与慢性炎症细胞因子标记物的关联。对于每个 为了实现这些目标，我们将进行亚组分析，以探讨这些关系是否因个体而异 诸如性别和年龄（> 50 vs. < 50）等特征，以及过去和当前吸食大麻的特征， 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 PLWH 中的大麻。研究结果将告知艾滋病毒治疗提供者和正在考虑的患者 大麻来控制艾滋病毒相关症状或艾滋病毒疾病本身，并将确定大麻的使用模式 与物质使用障碍的发生率密切相关。我们的研究团队是 跨学科，我们的基础设施已经到位，我们的初步数据支持该项目的需求。这 研究与当前 NIH HIV 研究重点一致，以减少 HIV 传播（通过成功 治疗和病毒抑制）并减少艾滋病毒相关合并症的发生，包括认知 功能障碍。