Longitudinal analysis of symptoms and healthcare utilization among daily cannabis-using persons living with HIV: impact of co-occurring cocaine use

BACKGROUND: Cannabis use is common among persons living with human immunodeficiency virus (HIV, PLWH) and has been associated with disrupted sleep, psychiatric symptoms, and increased healthcare utilization. However, the influence of concurrent cocaine and cannabis use on symptom trajectories and healthcare engagement remains unclear. METHODS: One hundred nineteen PLWH who reported daily cannabis use were assessed longitudinally: baseline, 3-month, and 6-month follow-up. Participants were stratified into concurrent cocaine users vs. non-users based on urine drug screen results (Coc + n = 34 vs. Coc- n = 85). Assessments included substance-use characteristics, viral load, healthcare utilization (HIV-specific vs. non-specific medical visits), HIV-related symptoms (poor sleep, fatigue, pain, poor appetite), and psychiatric symptoms (depression, anxiety). RESULTS: From baseline to 6-month follow-up, HIV clinic visit frequency declined 46.7% (p = 0.002), which was predicted by less-frequent baseline cannabis use (p = 0.03). Poor sleep, fatigue, and poor appetite reliably correlated with psychiatric symptom severity (rs = 0.23-0.57), whereas pain severity was most closely linked to non-HIV-specific healthcare utilization (rs = 0.23-0.36). Cocaine co-use was associated with greater non-HIV-specific healthcare utilization, worse sleep, and less-frequent cannabis use (ps < 0.05). CONCLUSIONS: Among daily cannabis-using PLWH, less-frequent cannabis use at study baseline predicted a 47% decline in HIV clinic visits suggesting that frequent cannabis use (or associated factors) may perpetuate continued HIV healthcare utilization. Cocaine co-use was associated with greater healthcare utilization, worse sleep quality, and less-frequent cannabis use, but did modulate self-reported depression or anxiety symptoms. In sum, our findings show a complex interplay between longitudinal patterns of cannabis use, somatic and psychiatric symptom severity, and healthcare utilization among PLWH. TRIAL REGISTRATION: This study was registered at ClinicalTrials.gov (NCT01536899).