By Jill Pease

In January, 2017 Florida’s Amendment 2 took effect, granting citizens with serious illnesses, including HIV, legal access to medical marijuana. While there is some evidence that marijuana may improve HIV-related symptoms, there is still a lot experts do not know about its health effects. University
of Florida researchers hope to answer some f these questions with a new study supported by a $3.2 million grant from the National Institute on Drug Abuse.

“Marijuana use is increasingly common in persons living with HIV infection. Yet, past findings regarding the health impact of marijuana use on HIV have been limited and inconclusive,” said Robert Cook, M.D., M.P.H., the study’s lead investigator and a professor of epidemiology and medicine in the UF College of Public Health and Health Professions and the UF College of Medicine, both part of UF Health. “The long-term goal of this research is to provide patients, clinicians and public health authorities with information to guide clinical and safety recommendations for marijuana use.”

Florida has the highest rate of new HIV infections and the third-highest number of people living with HIV infection in the U.S, nearly half of whom are now age 50 or older.

During the five-year study, UF researchers and partners at the University of South Florida and Florida International University plan to follow 400 Floridians with HIV who report current marijuana use. It is believed to be the largest and most comprehensive study to date on the health effects of marijuana in people with HIV.

“Marijuana contains a range of cannabinoid components, each of which could affect HIV health outcomes positively or negatively,” said Cook, the director of UF’s Southern HIV and Alcohol Research Consortium, or SHARC, Center for Translational HIV Research and the current chair of the Florida Consortium for HIV/AIDS Research. “These include behavioral effects, such as medication adherence and planning, and effects on the body, including chronic inflammation and viral suppression.”

At the University of Florida, study collaborators are scientists from across UF Health with expertise in biostatistics, cognition, substance use and toxicology, including Babette Brumback, Ph.D.; Ronald Cohen, Ph.D.; Linda B. Cottler, Ph.D., M.P.H.; and Bruce Goldberger, Ph.D.
The research team will track the quantity, frequency and cannabinoid content of marijuana used by participants in order to identify patterns of use most strongly associated with control of patient symptoms, such as pain, stress and sleep problems.

“Many persons using marijuana for specific health indications may have identified specific strategies to use marijuana that they find to be most effective, and we can learn from their experience,” Cook said. “This information can help to inform clinical care and identify specific types and patterns of marijuana use to be studied in future randomized clinical trials.”

The team will evaluate marijuana’s effect on participants’ health outcomes, and through neurocognitive testing, they hope to gain an understanding of how marijuana may affect thinking, memory and planning in people with HIV.

The researchers will also compare outcomes in people who receive medical marijuana with outcomes in those who use recreationally and will track long-term use of opioids in these populations.

“We expect the study to contribute to clinical and public health guidelines, while also addressing knowledge gaps about how much marijuana is ‘too much’ and how the effects of marijuana may be different in older individuals,” Cook said.

Funding of the new study is one of a long line of recent scientific successes for Cook and members of the SHARC team, who have published more than a dozen studies in the last year alone focusing on various health issues among people with HIV, including alcohol use, smoking and depression. The SHARC team also received another NIH grant this year, along with collaborators at the University of Miami, the University of Louisville and the Florida Department of Health, to identify strategies to help reduce alcohol-related harms in people infected with HIV.

“We have a shared vision of a day when people affected by alcohol, substance abuse, mental health and HIV can have the same quality of life and health outcomes as everyone else,” Cook said.