Beyond Cigarettes: Cannabis Co-Use, ART Adherence, and Psychosocial Burden Among People With HIV Enrolled in a Smoking Cessation Randomized Controlled Trial

Objective: Cannabis co-use is common among people with HIV (PWH) who smoke cigarettes yet is infrequently measured in smoking cessation trials. We report the relationship of baseline co-use status, HIV-related variables, and factors associated with tobacco treatment success (e.g., psychosocial characteristics) among PWH enrolled in an ongoing RCT evaluating a tailored app-based smoking cessation treatment. Method: U.S. adults who smoked ≥5 cigarettes per day and were willing to set a quit date were recruited nationally online and via community-based HIV clinics in Florida. At baseline, HIV-related variables, socio-demographics, psychosocial characteristics, tobacco use history, cannabis use history and modality, and other substance use were assessed. Participants were classified as co-using at baseline if they reported using any form of cannabis in the past 30 days. Results: Participants who co-used cannabis (n=142, 28%) vs. did not (n=370, 72%) were more likely to be younger, Black, lesbian, gay, or bisexual, live in a household with another person who smokes, use other combustible tobacco products, report other recreational drug use in the past year, and have higher self-reported health. Compared to participants who did not use cannabis, co-use participants more often reported missed doses of ART in the past month (53% vs. 37%), loss of appetite or change in the taste of food (48% vs. 38%), frequent alcohol use, financial strain, loneliness, discrimination, and better perceived general health (p values < .05). They frequently reported blunt use and same-occasion cannabis and tobacco use. Conclusions: Study findings indicate that PWH who co-use experience elevated behavioral and psychosocial risk factors associated with reduced smoking cessation success and worse HIV-related outcomes.