Alcohol and Cannabis Use in Relation to Pain and Negative Affect in People with HIV

HIV-associated painful neuropathies affect up to 69% of people with HIV (PWH), and chronic pain often promotes additional negative affective co-morbidities (e.g., anxiety, depression, PTSD) that dramatically reduce quality of life in PWH. Alcohol and cannabis are frequently used to manage pain and negative affective conditions, although chronic self-medication with these substances may facilitate the development of substance use disorders in PWH over time.The current study examined relationships among alcohol use (blood phosphatidylethanol levels, PEth), recent and lifetime cannabis use (addiction severity index), pain-related symptoms (SF-36 pain and pain interference measures), and negative affect (Hospital Anxiety and Depression Scale, HADS) in the baseline New Orleans Alcohol Use in HIV (NOAH) cohort (n=365) of PWH. Recent alcohol consumption (PEth-positive status) was significantly associated with reductions in pain intensity and interference while positive relationships were observed between pain symptoms and negative affect. Alcohol use appeared to promote sex-dependent associations between pain and negative affect. Pain symptoms correlated with HADS-Anxiety in female drinkers (but not non-drinkers), while pain symptoms correlated with HADS-Depression in male drinkers (but not non-drinkers). Additionally, 71% of the NOAH cohort had a history of one year or more of cannabis use, with 36% of the cohort using cannabis in the past month. Neither recent nor lifetime cannabis use was associated with self-reported pain symptoms. However, lifetime cannabis use was significantly associated with self-reported pain interference, and this effect was specifically pronounced in males. These findings suggest strong interactions between both alcohol and cannabis use and somatic and affective pain symptomatology in PWH in a sex-specific manner. As a mechanistic integration of our clinical studies, ongoing work in our non-human primate model of SIV infection is examining adaptations in brain and peripheral endocannabinoid signaling produced by chronic alcohol exposure. R01-AA025996 (SE) P60-AA009803 (PM) T32-AA007577 (PM) F30-AA031900 (SL) This abstract was presented at the American Physiology Summit 2025 and is only available in HTML format. There is no downloadable file or PDF version. The Physiology editorial board was not involved in the peer review process.