Kipp Aaron M, Rebeiro Peter F, Shepherd Bryan E, Brinkley-Rubinstein Lauren, Turner Megan, Bebawy Sally, Sterling Timothy R, Hulgan Todd
Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
Vanderbilt Institute for Medicine and Public Health, 2525 West End Ave., Suite 614, Nashville, TN, 37203, USA.
AIDS Behav. 2017 Jul;21(7):1996-2004. doi: 10.1007/s10461-017-1716-7.
We assessed the association between marijuana use and retention in HIV care through a retrospective cohort study of patients engaged in care at a large HIV clinic in 2011 and 2012. Two different retention outcomes were assessed: not meeting the Institute of Medicine's (IOM) retention definition (≥2 provider visits ≥90 days apart in a calendar year) and no-show visits. Any marijuana use and frequency of marijuana use were obtained from a substance use screening questionnaire administered at each clinic visit. Modified Poisson regression was used to estimate risk ratios and 95% confidence intervals for the association between marijuana use and retention outcomes. Marijuana use was reported by 17% of 1791 patients and 21% were not retained (IOM definition). Marijuana use was not associated with the IOM retention outcome, but was associated with missing the next scheduled appointment. A non-linear dose-response was observed for frequency of marijuana use and missed visits, with daily users having the highest risk compared to non-users. Daily marijuana use had a negative impact on HIV clinic attendance. Further research is needed to elucidate the mechanisms by which marijuana use affects this outcome to inform targeted interventions.
我们通过一项回顾性队列研究，评估了2011年和2012年在一家大型艾滋病诊所接受治疗的患者中，使用大麻与艾滋病护理留存率之间的关联。评估了两种不同的留存结果：未达到医学研究所（IOM）的留存定义（在一个日历年中，≥2次就诊，且就诊间隔≥90天）和爽约就诊。每次诊所就诊时通过一份物质使用筛查问卷获取任何大麻使用情况及大麻使用频率。采用修正泊松回归来估计大麻使用与留存结果之间关联的风险比及95%置信区间。1791名患者中有17%报告使用过大麻，21%未留存（IOM定义）。大麻使用与IOM留存结果无关，但与错过下一次预约就诊有关。观察到大麻使用频率与错过就诊之间存在非线性剂量反应关系，与不使用者相比，每日使用者风险最高。每日使用大麻对艾滋病诊所就诊率有负面影响。需要进一步研究以阐明大麻使用影响这一结果的机制，为有针对性的干预措施提供依据。
