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Bando JM, Tashkin DP, Barjaktarevic IZ. Impact of Marijuana Use on Lung Health. Semin Respir Crit Care Med 2024. [PMID: 38968961 DOI: 10.1055/s-0044-1785679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/07/2024]
Abstract
The widespread use of marijuana in the context of increasing legalization has both short- and long-term health implications. Although various modes of marijuana use-smoked, vaped, or ingested-may lead to a wide scope of potential systemic effects, we focus here on inhalational use of marijuana as the most common mode with the lung as the organ that is most directly exposed to its effects. Smoked marijuana has been associated with symptoms of chronic bronchitis and histopathologic changes in airway epithelium, but without consistent evidence of long-term decline in pulmonary function. Its role in immunomodulation, both for risk of infection and protection against a hyperinflammatory host response to infection, has been suggested in animal models and in vitro without conclusive extrapolation to humans. Marijuana smoke contains carcinogens like those found in tobacco, raising concern about its role in lung cancer, but evidence is mixed and made challenging by concurrent tobacco use. Vaping may offer a potential degree of harm reduction when compared with smoking marijuana with reduction of exposure to several toxins, including carbon monoxide, and reduction in chronic respiratory symptoms. However, these potential benefits are counterbalanced by risks including vaping-associated lung injury, potentially more intense drug exposure, and other yet not well-understood toxicities. As more states legalize marijuana and the federal government considers changing this from a Schedule I to a Schedule III controlled substance, we anticipate an increase in prospective medical studies concerning the risks related to marijuana use. This review is based on currently available data concerning the impact of inhaled marijuana on lung health.
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Affiliation(s)
- Joanne M Bando
- Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Donald P Tashkin
- Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Igor Z Barjaktarevic
- Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
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2
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Parisi CE, Wang Y, Varma DS, Vaddiparti K, Ibañez GE, Carrillo LC, Cook RL. Changes in frequency of cannabis use among people with HIV during the COVID-19 pandemic: a multi-methods study to explore the underlying reasons for change. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2023; 49:470-480. [PMID: 36898081 PMCID: PMC10695005 DOI: 10.1080/00952990.2023.2176234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 01/24/2023] [Accepted: 01/31/2023] [Indexed: 03/12/2023]
Abstract
Background: People with HIV (PWH) report higher rates of cannabis use than the general population. It is unclear how cannabis use among PWH has been impacted by the COVID-19 pandemic and the implications for the health and wellbeing of PWH.Objectives: To describe changes in frequency of cannabis use among a sample of PWH during the pandemic, reasons for those changes, and implications of the findings.Methods: The data are cross-sectional and come from questions asked in a follow-up phone survey administered to a prospective cohort of PWH in Florida between May 2020 and March 2021. Participants who used cannabis were asked about changes in their frequency of cannabis use in a quantitative survey and reasons for changes in a qualitative open-ended question. Qualitative data were analyzed using thematic analysis.Results: Among 227 PWH (mean age 50, 50% men, 69% Black/African American, 14% Hispanic/Latino), 13% decreased frequency of cannabis, 11% increased frequency, and 76% reported no change. The most common reasons for increasing frequency of cannabis use were reducing anxiety/stress, trying to relax, coping with grief or reducing symptoms of depression, and reducing boredom during the pandemic. Supply or access issues, health concerns, and having already wanted to reduce cannabis use were common reasons for decreased frequency.Conclusion: Nearly 25% of the sample changed their cannabis use frequency during the pandemic. These findings shed light on the behaviors and motivations of PWH who use cannabis and can inform clinical practice and interventions during public health emergencies and beyond.
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Affiliation(s)
| | - Yan Wang
- Department of Epidemiology, University of Florida, Gainesville, FL USA
| | - Deepthi S. Varma
- Department of Epidemiology, University of Florida, Gainesville, FL USA
| | | | - Gladys E. Ibañez
- Department of Epidemiology, Florida International University, Miami, FL USA
| | | | - Robert L. Cook
- Department of Epidemiology, University of Florida, Gainesville, FL USA
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3
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Abstract
PURPOSE OF REVIEW As people living with human immunodeficiency virus (HIV, PLWH) age, aging-related comorbidities have come into focus as major challenges to their overall health. In this review, an in-depth overview of the two most commonly encountered chronic lung diseases in PLWH, chronic obstructive pulmonary disease (COPD) and lung cancer, is provided. RECENT FINDINGS The risk for both COPD and lung cancer remains significantly higher in PLWH compared to the HIV-uninfected population, although fortunately rates of lung cancer appear to be declining over the last two decades. Outcomes for PLWH with these conditions, though, continue to be poor with worse survival rates in comparison to the general population. PLWH still face major barriers in accessing care for these conditions, including a higher likelihood of being underdiagnosed with COPD and a lower likelihood of being referred for lung cancer screening or treatment. A lack of evidence for optimal treatment strategies for both COPD and lung cancer still hampers the care of PLWH with these conditions. SUMMARY COPD and lung cancer represent substantial burdens of disease in PLWH. Improved access to standard-of-care screening and treatment and greater investigation into therapeutic responses specifically in this population are recommended.
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Affiliation(s)
- Janice M Leung
- Division of Respiratory Medicine, Department of Medicine
- Centre for Heart Lung Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
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4
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Nayak AP, Loblundo C, Bielory L. Immunomodulatory Actions of Cannabinoids: Clinical Correlates and Therapeutic Opportunities for Allergic Inflammation. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:449-457. [PMID: 36280137 PMCID: PMC9918686 DOI: 10.1016/j.jaip.2022.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 10/05/2022] [Accepted: 10/09/2022] [Indexed: 11/06/2022]
Abstract
Endogenously produced cannabinoids as well as phytocannabinoids broadly exhibit anti-inflammatory actions. Recent emergence of cannabis for multiple medical issues combined with reports on potent immunomodulatory actions of distinct components has underscored the therapeutic potential of cannabis. Although synthetic cannabinoids that are based on structural similarities to the existing class of cannabinoids have been on the rise, their application in therapeutics have been limited owing to toxicity concerns. Herein, we review the current literature that details the immunomodulatory actions of cannabinoids. Further, we highlight the complexities of cannabinoid biology and examine the potential inflammatory risks associated with the use of cannabis including potential for toxic interactions between distinct constituents of cannabis.
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Affiliation(s)
- Ajay P Nayak
- Department of Medicine, Thomas Jefferson University, Philadelphia, Pa; Center for Translational Medicine; Division of Pulmonary Allergy and Critical Care Medicine, Jane and Leonard Korman Lung Center, Thomas Jefferson University, Philadelphia, Pa.
| | - Cali Loblundo
- Department of Medicine, Thomas Jefferson University, Philadelphia, Pa; Center for Translational Medicine; Division of Pulmonary Allergy and Critical Care Medicine, Jane and Leonard Korman Lung Center, Thomas Jefferson University, Philadelphia, Pa
| | - Leonard Bielory
- Department of Medicine, Thomas Jefferson University, Philadelphia, Pa; Department of Medicine, Hackensack Meridian School of Medicine, Nutley, NJ; Rutgers University Center for Environmental Prediction, New Brunswick, NJ; Center for Aerobiological Research, Kean University, Union, NJ.
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5
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Tashkin DP, Tan WC. Inhaled Marijuana and the Lung. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2022; 10:2822-2829. [PMID: 35609784 DOI: 10.1016/j.jaip.2022.05.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 04/28/2022] [Accepted: 05/11/2022] [Indexed: 10/18/2022]
Abstract
Although vaping has recently increased as a mode of inhaling marijuana and has been associated with numerous and sometimes fatal cases of acute severe lung injury, smoking remains the most common method of inhaling marijuana and has been studied more extensively. Smoking marijuana has been shown to produce modest but significant short-term bronchodilation both in healthy subjects and those with asthma. Long-term effects of habitual marijuana smoking include the following: 1) symptoms of chronic bronchitis (increased cough, sputum production and wheezing); 2) modest effects on lung function in cross-sectional studies (no significant decrease in forced expired volume in 1 second [FEV1) but mild reductions in FEV1/forced vital capacity ratio [FEV1/FVC], an increase in FVC and other lung volumes, reductions in specific airway conductance, and variable effects of maximal mid-expiratory flow rates and diffusing capacity; and 3) variable effects on age-related decline in FEV1 in longitudinal studies. Most cohort and case-control studies have failed to show that marijuana smoking is a significant risk-factor for lung cancer despite the presence of pro-carcinogenic components in marijuana smoke, although further study is warranted. The question whether marijuana smoking is associated with asthma is unclear and requires further investigation. Although delta-9 tetrahydrocannabinol (THC), the principal psychoactive component of marijuana, has immunomodulatory properties that hypothetically could increase the risk of pneumonia, the few available studies in marijuana smokers have failed to find an increased risk of pneumonia in immunocompetent users, although effects in immunosuppressed individuals have been variable.
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Affiliation(s)
- Donald P Tashkin
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, David Geffen School of Medicine at UCLA Health Sciences, Los Angeles, CA 90095, USA
| | - Wan-Cheng Tan
- Division of Respiratory Medicine, Department of Medicine, University of British Columbia, V6Z 1Y6, Canada
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Barré T, Mercié P, Lions C, Miailhes P, Zucman D, Aumaître H, Esterle L, Sogni P, Carrieri P, Salmon-Céron D, Marcellin F, Salmon D, Wittkop L, Sogni P, Esterle L, Trimoulet P, Izopet J, Serfaty L, Paradis V, Spire B, Carrieri P, Valantin MA, Pialoux G, Chas J, Poizot-Martin I, Barange K, Naqvi A, Rosenthal E, Bicart-See A, Bouchaud O, Gervais A, Lascoux-Combe C, Goujard C, Lacombe K, Duvivier C, Neau D, Morlat P, Bani-Sadr F, Meyer L, Boufassa F, Autran B, Roque AM, Solas C, Fontaine H, Costagliola D, Piroth L, Simon A, Zucman D, Boué F, Miailhes P, Billaud E, Aumaître H, Rey D, Peytavin G, Petrov-Sanchez V, Levier A, Usubillaga R, Terris B, Tremeaux P, Katlama C, Valantin MA, Stitou H, Cacoub P, Nafissa S, Benhamou Y, Charlotte F, Fourati S, Zaegel O, Laroche H, Tamalet C, Callard P, Bendjaballah F, Le Pendeven C, Marchou B, Alric L, Metivier S, Selves J, Larroquette F, Rio V, Haudebourg J, Saint-Paul MC, De Monte A, Giordanengo V, Partouche C, Martin A, Ziol M, Baazia Y, Iwaka-Bande V, Gerber A, Uzan M, Garipuy D, Ferro-Collados MJ, Nicot F, Yazdanpanah Y, Adle-Biassette H, Alexandre G, Molina JM, Bertheau P, Chaix ML, Delaugerre C, Maylin S, Bottero J, Krause J, Girard PM, Wendum D, Cervera P, Adam J, Viala C, Vittecocq D, Quertainmont Y, Teicher E, Pallier C, Lortholary O, Rouzaud C, Lourenco J, Touam F, Louisin C, Avettand-Fenoel V, Gardiennet E, Mélard A, Ochoa A, Blanchard E, Castet-Lafarie S, Cazanave C, Malvy D, Dupon M, Dutronc H, Dauchy F, Lacaze-Buzy L, Desclaux A, Bioulac-Sage P, Reigadas S, Lacoste D, Bonnet F, Bernard N, Hessamfar M, J, Paccalin F, Martell C, Pertusa MC, Vandenhende M, Mercié P, Pistone T, Receveur MC, Méchain M, Duffau P, Rivoisy C, Faure I, Caldato S, Bellecave P, Tumiotto C, Pellegrin JL, Viallard JF, Lazzaro E, Greib C, Majerholc C, Brollo M, Farfour E, Devoto JP, Kansau I, Chambrin V, Pignon C, Berroukeche L, Fior R, Martinez V, Abgrall S, Favier M, Deback C, Lévy Y, Dominguez S, Lelièvre JD, Lascaux AS, Melica G, Raffi F, Allavena C, Reliquet V, Boutoille D, Biron C, Lefebvre M, Hall N, Bouchez S, Rodallec A, Le Guen L, Hemon C, Peyramond D, Chidiac C, Ader F, Biron F, Boibieux A, Cotte L, Ferry T, Perpoint T, Koffi J, Zoulim F, Bailly F, Lack P, Maynard M, Radenne S, Amiri M, Valour F, Augustin-Normand C, Scholtes C, Le-Thi TT, Van Huyen PCMD, Buisson M, Waldner-Combernoux A, Mahy S, Rousseau AS, Martins C, Galim S, Lambert D, Nguyen Y, Berger JL, Hentzien M, Brodard V, Partisani M, Batard ML, Cheneau C, Priester M, Bernard-Henry C, de Mautort E, Fischer P, Gantner P, Fafi-Kremer S, Roustant F, Platterier P, Kmiec I, Traore L, Lepuil S, Parlier S, Sicart-Payssan V, Bedel E, Anriamiandrisoa S, Pomes C, Mole M, Bolliot C, Catalan P, Mebarki M, Adda-Lievin A, Thilbaut P, Ousidhoum Y, Makhoukhi FZ, Braik O, Bayoud R, Gatey C, Pietri MP, Le Baut V, Rayana RB, Bornarel D, Chesnel C, Beniken D, Pauchard M, Akel S, Lions C, Ivanova A, Ritleg AS, Debreux C, Chalal L, Zelie J, Hue H, Soria A, Cavellec M, Breau S, Joulie A, Fisher P, Gohier S, Croisier-Bertin D, Ogoudjobi S, Brochier C, Thoirain-Galvan V, Le Cam M, Chalouni M, Conte V, Dequae-Merchadou L, Desvallees M, Gilbert C, Gillet S, Knight R, Lemboub T, Marcellin F, Michel L, Mora M, Protopopescu C, Roux P, Tezkratt S, Barré T, Rojas TR, Baudoin M, Di Beo MSV, Nishimwe M. HCV cure: an appropriate moment to reduce cannabis use in people living with HIV? (ANRS CO13 HEPAVIH data). AIDS Res Ther 2022; 19:15. [PMID: 35292069 PMCID: PMC8922772 DOI: 10.1186/s12981-022-00440-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 03/06/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Thanks to direct-acting antivirals, hepatitis C virus (HCV) infection can be cured, with similar rates in HCV-infected and HIV-HCV co-infected patients. HCV cure is likely to foster behavioral changes in psychoactive substance use, which is highly prevalent in people living with HIV (PLWH). Cannabis is one substance that is very commonly used by PLWH, sometimes for therapeutic purposes. We aimed to identify correlates of cannabis use reduction following HCV cure in HIV-HCV co-infected cannabis users and to characterize persons who reduced their use. METHODS We used data collected on HCV-cured cannabis users in a cross-sectional survey nested in the ANRS CO13 HEPAVIH cohort of HIV-HCV co-infected patients, to perform logistic regression, with post-HCV cure cannabis reduction as the outcome, and socio-behavioral characteristics as potential correlates. We also characterized the study sample by comparing post-cure substance use behaviors between those who reduced their cannabis use and those who did not. RESULTS Among 140 HIV-infected cannabis users, 50 and 5 had reduced and increased their use, respectively, while 85 had not changed their use since HCV cure. Cannabis use reduction was significantly associated with tobacco use reduction, a decrease in fatigue level, paying more attention to one's dietary habits since HCV cure, and pre-HCV cure alcohol abstinence (p = 0.063 for alcohol use reduction). CONCLUSIONS Among PLWH using cannabis, post-HCV cure cannabis reduction was associated with tobacco use reduction, improved well-being, and adoption of healthy behaviors. The management of addictive behaviors should therefore be encouraged during HCV treatment.
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Predictors of Transition to Frailty in Middle-Aged and Older People With HIV: A Prospective Cohort Study. J Acquir Immune Defic Syndr 2021; 88:518-527. [PMID: 34757975 DOI: 10.1097/qai.0000000000002810] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 08/31/2021] [Indexed: 01/01/2023]
Abstract
BACKGROUND People with HIV (PWH) have increased frailty risk at younger ages compared with the general population. Multimorbidity is associated with frailty, yet effects of specific comorbidities on transition to frailty in PWH are unknown. SETTING Prospective study of 219 PWH age 45 years or older in the National NeuroAIDS Tissue Consortium. METHODS Frailty status was categorized using Fried frailty phenotype criteria. Comorbidities [bone disease, cardiovascular disease, cerebrovascular disease, liver disease, renal disease, diabetes, chronic obstructive pulmonary disease (COPD), hypertension, obesity, cancers, neuropsychiatric conditions] were assessed from longitudinal data. Associations between baseline comorbidities and transition to frailty within 30 months were analyzed using Kaplan-Meier and Cox regression models. Grip strength was assessed using mixed-effects models. RESULTS At baseline, the median age was 61 years, 73% were male 98% were on antiretroviral therapy, 29% had ≥3 comorbidities, 27% were robust, and 73% were pre-frail. Cerebrovascular disease, diabetes, and COPD were independent predictors of transition to frailty within 30 months in models adjusted for age, sex, and multimorbidity (≥3 additional comorbidities) [hazard ratios (95% confidence intervals) 2.52 (1.29 to 4.93), 2.31 (1.12 to 4.76), and 1.82 (0.95 to 3.48), respectively]. Furthermore, cerebrovascular disease, diabetes, COPD, or liver disease co-occurring with multimorbidity was associated with substantially increased frailty hazards compared with multimorbidity alone (hazard ratios 4.75-7.46). Cerebrovascular disease was associated with decreased baseline grip strength (P = 0.0001), whereas multimorbidity, diabetes, and COPD were associated with declining grip strength (P < 0.10). CONCLUSIONS In older PWH, cerebrovascular disease, diabetes, COPD, or liver disease co-occurring with multimorbidity is associated with substantially increased risk of becoming frail within 30 months. Interventions targeting these comorbidities may ameliorate frailty and age-related functional decline in PWH.
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Jugl S, Okpeku A, Costales B, Morris EJ, Alipour-Haris G, Hincapie-Castillo JM, Stetten NE, Sajdeya R, Keshwani S, Joseph V, Zhang Y, Shen Y, Adkins L, Winterstein AG, Goodin A. A Mapping Literature Review of Medical Cannabis Clinical Outcomes and Quality of Evidence in Approved Conditions in the USA from 2016 to 2019. Med Cannabis Cannabinoids 2021; 4:21-42. [PMID: 34676348 PMCID: PMC8525213 DOI: 10.1159/000515069] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 02/03/2021] [Indexed: 12/15/2022] Open
Abstract
In 2017, a National Academies of Sciences, Engineering, and Medicine (NASEM) report comprehensively evaluated the body of evidence regarding cannabis health effects through the year 2016. The objectives of this study are to identify and map the most recently (2016-2019) published literature across approved conditions for medical cannabis and to evaluate the quality of identified recent systematic reviews, published following the NASEM report. Following the literature search from 5 databases and consultation with experts, 11 conditions were identified for evidence compilation and evaluation: amyotrophic lateral sclerosis, autism, cancer, chronic noncancer pain, Crohn's disease, epilepsy, glaucoma, human immunodeficiency virus/AIDS, multiple sclerosis (MS), Parkinson's disease, and posttraumatic stress disorder. A total of 198 studies were included after screening for condition-specific relevance and after imposing the following exclusion criteria: preclinical focus, non-English language, abstracts only, editorials/commentary, case studies/series, and non-U.S. study setting. Data extracted from studies included: study design type, outcome definition, intervention definition, sample size, study setting, and reported effect size. Few completed randomized controlled trials (RCTs) were identified. Studies classified as systematic reviews were graded using the Assessing the Methodological Quality of Systematic Reviews-2 tool to evaluate the quality of evidence. Few high-quality systematic reviews were available for most conditions, with the exceptions of MS (9 of 9 graded moderate/high quality; evidence for 2/9 indicating cannabis improved outcomes; evidence for 7/9 indicating cannabis inconclusive), epilepsy (3 of 4 graded moderate/high quality; 3 indicating cannabis improved outcomes; 1 indicating cannabis inconclusive), and chronic noncancer pain (12 of 13 graded moderate/high quality; evidence for 7/13 indicating cannabis improved outcomes; evidence from 6/7 indicating cannabis inconclusive). Among RCTs, we identified few studies of substantial rigor and quality to contribute to the evidence base. However, there are some conditions for which significant evidence suggests that select dosage forms and routes of administration likely have favorable risk-benefit ratios (i.e., epilepsy and chronic noncancer pain). The body of evidence for medical cannabis requires more rigorous evaluation before consideration as a treatment option for many conditions, and evidence necessary to inform policy and treatment guidelines is currently insufficient for many conditions.
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Affiliation(s)
- Sebastian Jugl
- Pharmaceutical Outcomes and Policy, University of Florida, Gainesville, Florida, USA
- Center for Drug Evaluation and Safety (CoDES), University of Florida, Gainesville, Florida, USA
| | - Aimalohi Okpeku
- Pharmaceutical Outcomes and Policy, University of Florida, Gainesville, Florida, USA
- Center for Drug Evaluation and Safety (CoDES), University of Florida, Gainesville, Florida, USA
| | - Brianna Costales
- Pharmaceutical Outcomes and Policy, University of Florida, Gainesville, Florida, USA
- Center for Drug Evaluation and Safety (CoDES), University of Florida, Gainesville, Florida, USA
| | - Earl J. Morris
- Pharmaceutical Outcomes and Policy, University of Florida, Gainesville, Florida, USA
- Center for Drug Evaluation and Safety (CoDES), University of Florida, Gainesville, Florida, USA
| | - Golnoosh Alipour-Haris
- Pharmaceutical Outcomes and Policy, University of Florida, Gainesville, Florida, USA
- Center for Drug Evaluation and Safety (CoDES), University of Florida, Gainesville, Florida, USA
| | - Juan M. Hincapie-Castillo
- Pharmaceutical Outcomes and Policy, University of Florida, Gainesville, Florida, USA
- Center for Drug Evaluation and Safety (CoDES), University of Florida, Gainesville, Florida, USA
| | | | - Ruba Sajdeya
- Epidemiology, University of Florida, Gainesville, Florida, USA
| | - Shailina Keshwani
- Pharmaceutical Outcomes and Policy, University of Florida, Gainesville, Florida, USA
- Center for Drug Evaluation and Safety (CoDES), University of Florida, Gainesville, Florida, USA
| | - Verlin Joseph
- Epidemiology, University of Florida, Gainesville, Florida, USA
| | - Yahan Zhang
- Pharmaceutical Outcomes and Policy, University of Florida, Gainesville, Florida, USA
- Center for Drug Evaluation and Safety (CoDES), University of Florida, Gainesville, Florida, USA
| | - Yun Shen
- Pharmaceutical Outcomes and Policy, University of Florida, Gainesville, Florida, USA
- Center for Drug Evaluation and Safety (CoDES), University of Florida, Gainesville, Florida, USA
| | - Lauren Adkins
- Health Sciences Center Libraries, University of Florida, Gainesville, Florida, USA
| | - Almut G. Winterstein
- Pharmaceutical Outcomes and Policy, University of Florida, Gainesville, Florida, USA
- Center for Drug Evaluation and Safety (CoDES), University of Florida, Gainesville, Florida, USA
| | - Amie Goodin
- Pharmaceutical Outcomes and Policy, University of Florida, Gainesville, Florida, USA
- Center for Drug Evaluation and Safety (CoDES), University of Florida, Gainesville, Florida, USA
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Krsak M, Wada NI, Plankey MW, Kinney GL, Epeldegui M, Okafor CN, Friedman MR, Palella FJ, Erlandson KM. Self-Reported Cannabis Use and Markers of Inflammation in Men Who Have Sex With Men With and Without HIV. Cannabis Cannabinoid Res 2021; 6:165-173. [PMID: 33912681 PMCID: PMC8064959 DOI: 10.1089/can.2019.0083] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Background: Chronic inflammation contributes to aging and organ dysfunction in the general population, and is a particularly important determinant of morbidity and mortality among people with HIV (PWH). The effect of cannabis use on chronic inflammation is not well understood among PWH, who use cannabis more frequently than the general population. Materials and Methods: We evaluated participants in the Multicenter AIDS Cohort Study (MACS) beginning in 2004 with available data on cannabis use and inflammatory biomarkers. Associations of current cannabis use with plasma concentrations of inflammatory markers were adjusted for hepatitis C, tobacco smoking, and comorbidities. Markers were analyzed individually and in exploratory factor analysis (EFA). Results: We included 1352 men within the MACS. Twenty-seven percent of HIV-negative men, 41% of HIV viremic men, and 35% of virologically suppressed men reported cannabis use at baseline. Among cannabis users, 20-25% in all groups defined by HIV serostatus were daily users, and the same proportion reported weekly use. The remaining ∼50% of users in all groups reported monthly or less frequent use. Four biomarker groupings were identified by EFA: Factor 1: immune activation markers; Factor 2: proinflammatory cytokines; Factor 3: Th1- and Th2-promoting cytokines; and Factor 4: inflammatory chemokines. In EFA, daily users had 30% higher levels of Factor 2 biomarkers than nonusers (p=0.03); this was the only statistically significant difference by cannabis use status. Among individual markers, concentrations of IL-1β, IL-2, IL-6, and IL-8 (Factor 2); IL-10 (Factor 3); and BAFF (Factor 1) were higher (p<0.05) among daily cannabis users than among nonusers, after adjusting for HIV serostatus and other covariates. Discussion: Associations between daily cannabis use and proinflammatory biomarker levels did not differ by HIV serostatus. Further prospective studies with measured cannabis components are needed to clarify the impact of these compounds on inflammation. Our findings can facilitate for hypothesis generation and selection of biomarkers to include in such studies.
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Affiliation(s)
- Martin Krsak
- Division of Infectious Diseases, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Nikolas I. Wada
- Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Michael W. Plankey
- Division of Infectious Diseases, Department of Medicine, Georgetown University Medical Center, Washington, District of Columbia, USA
| | - Gregory L. Kinney
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Marta Epeldegui
- Department of Obstetrics and Gynecology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
- University of California Los Angeles AIDS Institute, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
- Josson Comprehensive Cancer Center, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Chukwuemeka N. Okafor
- Department of Public Health, Robbins College of Health and Human Sciences, Baylor University, Waco, Texas, USA
| | - Mackey Reuel Friedman
- Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Frank J. Palella
- Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Kristine M. Erlandson
- Division of Infectious Diseases, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
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Lorenz DR, Misra V, Chettimada S, Uno H, Wang L, Blount BC, De Jesús VR, Gelman BB, Morgello S, Wolinsky SM, Gabuzda D. Acrolein and other toxicant exposures in relation to cardiovascular disease among marijuana and tobacco smokers in a longitudinal cohort of HIV-positive and negative adults. EClinicalMedicine 2021; 31:100697. [PMID: 33554087 PMCID: PMC7846668 DOI: 10.1016/j.eclinm.2020.100697] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Marijuana smoke contains some of the same toxicants present in tobacco smoke. Marijuana smoking is prevalent among HIV+ individuals, but few studies have characterized smoke-related toxicants or associated health outcomes in exclusive marijuana users. METHODS This longitudinal study included 245 participants over age 40 (76% HIV+). 33 plasma and 28 urine metabolites of nicotine, ∆-9-trans-tetrahydrocannabinol, polycyclic aromatic hydrocarbons, and volatile organic compounds were assayed by liquid or gas chromatography/mass spectrometry. Exposures and health outcomes were assessed from surveys and medical records. FINDINGS At baseline, 18% of participants were marijuana-only smokers, 20% tobacco-only smokers, and 24% dual marijuana-tobacco smokers (median (IQR) age 53 (47-60) years, 78% male, 54% white race). Marijuana smoking was independently associated with elevated plasma naphthalenes, 2-hydroxyfluorene sulfate, 4-vinylphenol sulfate, and o-cresol sulfate (p<0·05) and urine acrylonitrile and acrylamide metabolites (p<0·05), but levels were lower than those associated with tobacco smoking. Acrolein metabolite N-Acetyl-S-(3-hydroxypropyl)-l-cysteine (3HPMA) was significantly elevated in plasma and urine in tobacco-only and dual but not marijuana-only smokers, and correlated with nicotine metabolites (p<0·05). The highest tertile of 3HPMA was associated with increased cardiovascular disease diagnoses independent of tobacco smoking, traditional risk factors, and HIV status (odds ratio [95% CI] 3·34 [1·31-8·57]; p = 0·012). INTERPRETATION Smoke-related toxicants, including acrylonitrile and acrylamide metabolites, are detectable in exclusive marijuana smokers, but exposures are lower compared with tobacco or dual smokers. Acrolein exposure is increased by tobacco smoking but not exclusive marijuana smoking in HIV+ and HIV- adults, and contributes to cardiovascular disease in tobacco smokers. FUNDING U.S. NIH.
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Affiliation(s)
- David R. Lorenz
- Department of Cancer Immunology and Virology, Dana-Farber Cancer Institute, Center for Life Science 1010, 450 Brookline Avenue, Boston, MA 02215, USA
| | - Vikas Misra
- Department of Cancer Immunology and Virology, Dana-Farber Cancer Institute, Center for Life Science 1010, 450 Brookline Avenue, Boston, MA 02215, USA
| | - Sukrutha Chettimada
- Department of Cancer Immunology and Virology, Dana-Farber Cancer Institute, Center for Life Science 1010, 450 Brookline Avenue, Boston, MA 02215, USA
| | - Hajime Uno
- Department of Data Sciences, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Lanqing Wang
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Benjamin C. Blount
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Víctor R. De Jesús
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Benjamin B. Gelman
- Department of Pathology, University of Texas Medical Branch, Galveston, TX, USA
| | - Susan Morgello
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Steven M. Wolinsky
- Division of Infectious Diseases, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Dana Gabuzda
- Department of Cancer Immunology and Virology, Dana-Farber Cancer Institute, Center for Life Science 1010, 450 Brookline Avenue, Boston, MA 02215, USA
- Corresponding author.
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11
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Gracie K, Hancox RJ. Cannabis use disorder and the lungs. Addiction 2021; 116:182-190. [PMID: 32285993 DOI: 10.1111/add.15075] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 03/04/2020] [Accepted: 03/31/2020] [Indexed: 12/11/2022]
Abstract
Cannabis is one of the world's most widely used recreational drugs and the second most commonly smoked substance. Research on cannabis and the lungs has been limited by its illegal status, the variability in strength and size of cannabis cigarettes (joints), and the fact that most cannabis users also smoke tobacco, making the effects difficult to separate. Despite these difficulties, the available evidence indicates that smoking cannabis causes bronchitis and is associated with changes in lung function. The pattern of effects is surprisingly different from that of tobacco. Whereas smoking cannabis appears to increase the risk of severe bronchitis at quite low exposure, there is no convincing evidence that this leads to chronic obstructive pulmonary disease. Instead, cannabis use is associated with increased central airway resistance, lung hyperinflation and higher vital capacity with little evidence of airflow obstruction or impairment of gas transfer. There are numerous reports of severe bullous lung disease and pneumothorax among heavy cannabis users, but convincing epidemiological data of an increased risk of emphysema or alveolar destruction are lacking. An association between cannabis and lung cancer remains unproven, with studies providing conflicting findings.
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Affiliation(s)
- Kathryn Gracie
- Department of Respiratory Medicine, Waikato Hospital, Hamilton, New Zealand
| | - Robert J Hancox
- Department of Respiratory Medicine, Waikato Hospital, Hamilton, New Zealand.,Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
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12
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Shiau S, Bender AA, O'Halloran JA, Sundermann E, Aggarwal J, Althoff KN, Baker JV, Deeks S, Fried LP, Karpiak S, Karris MY, Marcotte TD, Nachega JB, Margolick JB, Erlandson KM, Moore DJ. The Current State of HIV and Aging: Findings Presented at the 10th International Workshop on HIV and Aging. AIDS Res Hum Retroviruses 2020; 36:973-981. [PMID: 32847368 PMCID: PMC7703090 DOI: 10.1089/aid.2020.0128] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
With increasing effectiveness of antiretroviral therapy, people with HIV (PWH) are living longer and the prevalence of older PWH continues to increase. Accordingly, PWH are experiencing an increased burden of age-related comorbidities. With this shifting demographics, clinicians and researchers face additional challenges in how to identify, address, and manage the complex intersections of HIV- and aging-related conditions. Established in 2009, the International Workshop on HIV and Aging brings together clinicians and researchers in cross-disciplinary fields along with community advocates and PWH to address the multidisciplinary nature of HIV and aging. This article summarizes plenary talks from the 10th Annual International Workshop on HIV and Aging, which took place in New York City on October 10 and 11, 2019. Presentation topics included the following: the burdens of HIV-associated comorbidities, aging phenotypes, community engagement, and loneliness; these issues are especially important for older PWH, considering the current COVID-19 pandemic. We also discuss broad questions and potential directions for future research necessary to better understand the interaction between HIV and aging.
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Affiliation(s)
- Stephanie Shiau
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, New Jersey, USA
| | - Alexis A. Bender
- Division of General Medicine and Geriatrics, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Jane A. O'Halloran
- Division of Infectious Diseases, Department of Medicine, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Erin Sundermann
- Department of Psychiatry, University of California, San Diego, La Jolla, California, USA
| | - Juhi Aggarwal
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, New Jersey, USA
| | - Keri N. Althoff
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Jason V. Baker
- Division of Infectious Diseases, Hennepin Health Care, Minneapolis, Minnesota, USA
| | - Steven Deeks
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Linda P. Fried
- Department of Epidemiology and Robert N. Butler Columbia Aging Center, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Stephen Karpiak
- ACRIA Center on HIV & Aging at Gay Men's Health Crisis (GMHC) and College of Nursing, New York University, New York, New York, USA
| | - Maile Y. Karris
- Department of Medicine, University of California, San Diego, La Jolla, California, USA
| | - Thomas D. Marcotte
- Department of Psychiatry, University of California, San Diego, La Jolla, California, USA
| | - Jean B. Nachega
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania, USA
| | - Joseph B. Margolick
- Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Kristine M. Erlandson
- Department of Medicine, University of Colorado-Anschutz Medical Campus, Aurora, Colorado, USA
| | - David J. Moore
- Department of Psychiatry, University of California, San Diego, La Jolla, California, USA
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13
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Javed F, Al-Zawawi AS, Allemailem KS, Almatroudi A, Mehmood A, Divakar DD, Al-Kheraif AA. Periodontal Conditions and Whole Salivary IL-17A and -23 Levels among Young Adult Cannabis sativa (Marijuana)-Smokers, Heavy Cigarette-Smokers and Non-Smokers. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17207435. [PMID: 33066031 PMCID: PMC7601049 DOI: 10.3390/ijerph17207435] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 09/26/2020] [Accepted: 10/09/2020] [Indexed: 12/14/2022]
Abstract
In the United States, prevalence of marijuana-use has doubled in the past 2 decades. The aim was to compare the periodontal conditions and whole-salivary IL-17A and IL-23 levels among young adult marijuana-smokers, heavy cigarette-smokers and non-smokers. Self-reported marijuana-smokers, heavy-cigarette-smokers, non-smokers with periodontitis and periodontally-healthy non-smokers were included. Demographic data was recorded and full-mouth plaque index (PI), bleeding on probing (BoP), probing depth (PD) and clinical attachment loss (AL), marginal bone loss (MBL) and missing teeth were recorded. Levels of IL-17A and IL-23 levels were measured in the whole saliva. p < 0.01 was considered statistically significant. Fifteen-marijuana-smokers, 15 heavy-cigarette-smokers, 16 non-smokers-with-periodontitis and 15 periodontally-healthy-non-smokers) were included. The clinicoradiographic parameters were worse among marijuana-smokers (p < 0.01), cigarette-smokers (p < 0.01) and non-smokers-with-periodontitis (p < 0.01) than periodontally-healthy-non-smokers. Marijuana- and cigarette-smokers had Stage-IV/Grade C and non-smokers with periodontitis had Stage-III/Grade-C. Salivary IL-17A and IL-23 levels were higher in marijuana-smokers than cigarette-smokers (p < 0.01) and non-smokers-with-periodontitis (p < 0.01). Whole salivary IL-17A and IL-23 levels were higher among cigarette-smokers than non-smokers with periodontitis (p < 0.01) and periodontally-healthy-individuals (p < 0.01). Marijuana- and heavy cigarette-smokers have comparable clinicoradiographic periodontal statuses. This rejects hypothesis-1. However, whole salivary immunoinflammatory response may be moderately worse in marijuana-smokers compared with heavy cigarette-smokers and non-smoker with periodontitis thereby supporting hypothesis-2.
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Affiliation(s)
- Fawad Javed
- Department of Orthodontics and Dentofacial Orthopedics, Eastman Institute for Oral Health, University of Rochester, Rochester, NY 14620, USA;
| | - Abeer S. Al-Zawawi
- Department of Periodontics and Community Dentistry, King Saud University, Riyadh 60169, Saudi Arabia;
| | - Khaled S. Allemailem
- Department of Medical Laboratories, College of Applied Medical Sciences, Qassim University, Buraydah 51452, Saudi Arabia; (K.S.A.); (A.A.)
| | - Ahmad Almatroudi
- Department of Medical Laboratories, College of Applied Medical Sciences, Qassim University, Buraydah 51452, Saudi Arabia; (K.S.A.); (A.A.)
| | - Abid Mehmood
- Department of Dentistry, Postgraduate Medical Center, Karachi 75500, Pakistan;
| | - Darshan Devang Divakar
- Dental Biomaterials Research Chair, Dental Health Department, College of Applied Medical Sciences, King Saud University, P.O. Box 10219, Riyadh 11433, Saudi Arabia;
| | - Abdulaziz A. Al-Kheraif
- Dental Biomaterials Research Chair, Dental Health Department, College of Applied Medical Sciences, King Saud University, P.O. Box 10219, Riyadh 11433, Saudi Arabia;
- Correspondence: ; Tel.: +966-5025-1250; Fax: +966-0541-1222
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14
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Wenger DS, Triplette M, Shahrir S, Akgun KM, Wongtrakool C, Brown ST, Kim JW, Soo Hoo GW, Rodriguez-Barradas MC, Huang L, Feemster LC, Zifodya J, Crothers K. Associations of marijuana with markers of chronic lung disease in people living with HIV. HIV Med 2020; 22:92-101. [PMID: 33022830 DOI: 10.1111/hiv.12966] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 08/21/2020] [Accepted: 08/26/2020] [Indexed: 12/18/2022]
Abstract
OBJECTIVES The relationship between marijuana use and markers of chronic lung disease in people living with HIV (PLWH) is poorly understood. METHODS We performed a cross-sectional analysis of the Examinations of HIV-Associated Lung Emphysema (EXHALE) study, including 162 HIV-positive patients and 138 participants without HIV. We modelled marijuana exposure as: (i) current daily or weekly marijuana smoking vs. monthly or less often; or (ii) cumulative marijuana smoking (joint-years). Linear and logistic regression estimated associations between marijuana exposure and markers of lung disease, adjusted for tobacco smoking and other factors. RESULTS In PLWH, current daily or weekly marijuana use was associated with a larger forced vital capacity (FVC), larger total lung capacity and increased odds of radiographic emphysema compared with marijuana non-smokers in adjusted models; these associations were not statistically significant in participants without HIV. Marijuana joint-years were associated with higher forced expiratory volume in 1 s and FVC in PLWH but not with emphysema. CONCLUSIONS In PLWH, marijuana smoking was associated with higher lung volumes and potentially with radiographic emphysema. No consistently negative associations were observed between marijuana and measures of chronic lung health.
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Affiliation(s)
- D S Wenger
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington, Seattle, WA, USA
| | - M Triplette
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington, Seattle, WA, USA.,Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - S Shahrir
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington, Seattle, WA, USA
| | - K M Akgun
- Department of Internal Medicine, Veterans Affairs (VA) Connecticut Healthcare System and Yale University School of Medicine, New Haven, CT, USA
| | - C Wongtrakool
- Atlanta VA Medical Center and Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - S T Brown
- Department of Medicine, James J. Peters VA Medical Center, Bronx, NY, USA.,Department of Medicine, Icahn School of Medicine at Mt. Sinai, New York, NY, USA
| | - J W Kim
- Department of Medicine, James J. Peters VA Medical Center, Bronx, NY, USA
| | - G W Soo Hoo
- VA Greater Los Angeles Healthcare System and Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - M C Rodriguez-Barradas
- Michael E. DeBakey VA Medical Center and Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - L Huang
- Center for AIDS Research, University of California at San Francisco, San Francisco, CA, USA
| | - L C Feemster
- VA Puget Sound Healthcare System, University of Washington, Seattle, WA, USA
| | - J Zifodya
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington, Seattle, WA, USA
| | - K Crothers
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington, Seattle, WA, USA.,VA Puget Sound Healthcare System, University of Washington, Seattle, WA, USA
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15
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Atteintes pulmonaires liées au cannabis inhalé. LA PRESSE MÉDICALE FORMATION 2020. [PMCID: PMC7531428 DOI: 10.1016/j.lpmfor.2020.09.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
La relation entre cannabis et pathologies pulmonaires est difficile à établir : le cannabis est souvent fumé-mélangé à du tabac (« joint ») et les fumeurs de cannabis fument souvent aussi des cigarettes de tabac. L’usage régulier de cannabis est un facteur de risque de bronchite chronique. Il n’y a pas d’association significative entre inhalation de fumée de cannabis et obstruction bronchique, typique de la BPCO. L’usage de cannabis peut augmenter le risque de sifflements thoraciques et/ou de développement d’un asthme. L’usage régulier de cannabis est un facteur de risque de pneumopathies infectieuses, avec un risque plus élevé chez les sujets immunodéprimés et notamment les patients infectés par le VIH. Les résultats des études épidémiologiques sur le risque de cancer bronchique chez les fumeurs de cannabis sont discordants. Des cas de pneumothorax, pneumomédiastin, pneumopéricarde et pneumorachis ont été décrits chez les fumeurs de cannabis. Les études épidémiologiques ne montrent pas d’association entre usage de cannabis et emphysème pulmonaire. Les cannabinoïdes de synthèse, plus récemment introduits sur le marché, ont une toxicité importante. Ils peuvent provoquer des pneumopathies sévères et/ou une dépression respiratoire sévère.
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16
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Quint JJ, Tashkin DP, McKay HS, Plankey MW, Stosor V, Friedman MR, Detels R. Marijuana use and pneumonia risk in a cohort of HIV-infected and HIV-uninfected men. Ann Epidemiol 2020; 52:64-70.e2. [PMID: 32763342 DOI: 10.1016/j.annepidem.2020.07.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 07/09/2020] [Accepted: 07/28/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND The prevalence of marijuana use is increasing in the United States. Marijuana smoking has been shown to impair the microbicidal activity of alveolar macrophages and decrease the number of ciliated epithelial cells in the bronchi with a parallel increase in the number of mucus-secreting surface epithelial cells, which may increase the risk of pneumonia. However, it remains unclear whether there is an association between smoking marijuana and pneumonia. METHODS Using data from the Multicenter AIDS Cohort Study (MACS), a long-term observational cohort study of men who have sex with men in the United States, we used Cox proportional hazards models to estimate the risk of pneumonia among HIV-infected (n = 2784) and HIV-uninfected (n = 2665) men from 1984 to 2013, adjusted for time-varying and fixed baseline covariates. RESULTS Weekly or daily marijuana use was not significantly associated with increased risk of pneumonia among HIV-uninfected men (adjusted hazard ratio; 95% confidence limits: 0.83, 0.56-1.23). In the disaggregated dose-response analysis, daily use (0.68, 0.34-1.35) was associated with a lower point estimate than weekly use [0.99, 0.79-1.25]. CONCLUSION Marijuana smoking was not associated with a significant increase in risk of pneumonia among HIV-infected or HIV-uninfected men.
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Affiliation(s)
- Joshua J Quint
- Department of Epidemiology, UCLA School of Public Health, Los Angeles, CA.
| | - Donald P Tashkin
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA
| | - Heather S McKay
- Department of Epidemiology, Johns Hopkins University, Baltimore, MD
| | - Michael W Plankey
- Department of Medicine, Division of Infectious Diseases, Georgetown University, Washington, DC
| | - Valentina Stosor
- Feinberg School of Medicine, Northwestern University, Chicago, IL
| | | | - Roger Detels
- Department of Epidemiology, UCLA School of Public Health, Los Angeles, CA
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17
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Inglet S, Winter B, Yost SE, Entringer S, Lian A, Biksacky M, Pitt RD, Mortensen W. Clinical Data for the Use of Cannabis-Based Treatments: A Comprehensive Review of the Literature. Ann Pharmacother 2020; 54:1109-1143. [DOI: 10.1177/1060028020930189] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Objective: To compile and synthesize the available literature describing medical cannabis use across various disease states. Data Sources: PubMed, EBSCO, and Google Scholar searches were conducted using MeSH and/or keywords. Study Selection and Data Extraction: Studies were included if they described the use of cannabis-based products and medications in the treatment of a predefined list of disease states in humans and were published in English. The extraction period had no historical limit and spanned through April 2019. Data Synthesis: Evidence was compiled and summarized for the following medical conditions: Alzheimer disease, amyotrophic lateral sclerosis, autism, cancer and cancer-associated adverse effects, seizure disorders, human immunodeficiency virus, inflammatory bowel disease, multiple sclerosis (MS), nausea, pain, posttraumatic stress disorder, and hospice care. Relevance to Patient Care and Clinical Practice: Based on identified data, the most robust evidence suggests that medical cannabis may be effective in the treatment of chemotherapy-induced nausea and vomiting, seizure disorders, MS-related spasticity, and pain (excluding diabetic neuropathy). Overall, the evidence is inconsistent and generally limited by poor quality. The large variation in cannabis-based products evaluated in studies limits the ability to make direct comparisons. Regardless of the product, a gradual dose titration was utilized in most studies. Cannabis-based therapies were typically well tolerated, with the most common adverse effects being dizziness, somnolence, dry mouth, nausea, and euphoria. Conclusions: As more states authorize medical cannabis use, there is an increasing need for high-quality clinical evidence describing its efficacy and safety. This review is intended to serve as a reference for clinicians, so that the risks and realistic benefits of medical cannabis are better understood.
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Affiliation(s)
| | | | | | | | - Anh Lian
- Intermountain Healthcare, Taylorsville, UT, USA
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18
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Lorenz DR, Misra V, Gabuzda D. Transcriptomic analysis of monocytes from HIV-positive men on antiretroviral therapy reveals effects of tobacco smoking on interferon and stress response systems associated with depressive symptoms. Hum Genomics 2019; 13:59. [PMID: 31779701 PMCID: PMC6883692 DOI: 10.1186/s40246-019-0247-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 10/17/2019] [Indexed: 02/08/2023] Open
Abstract
Background Tobacco smoking induces immunomodulatory and pro-inflammatory effects associated with transcriptome changes in monocytes and other immune cell types. While smoking is prevalent in HIV-infected (HIV+) individuals, few studies have investigated its effects on gene expression in this population. Here, we report whole-transcriptome analyses of 125 peripheral blood monocyte samples from ART-treated HIV+ and uninfected (HIV−) men enrolled in the Multicenter AIDS Cohort Study (MACS) (n = 25 HIV+ smokers, n = 60 HIV+ non-smokers, n = 40 HIV− non-smoking controls). Gene expression profiling was performed using Illumina HumanHT-12 Expression BeadChip microarrays. Differential expression analysis was performed with weighted linear regression models using the R limma package, followed by functional enrichment and Ingenuity Pathway analyses. Results A total of 286 genes were differentially expressed in monocytes from HIV+ smokers compared with HIV− non-smokers; upregulated genes (n = 180) were enriched for immune and interferon response, chemical/stress response, mitochondria, and extracellular vesicle gene ontology (GO) terms. Expression of genes related to immune/interferon responses (AIM2, FCGR1A-B, IFI16, SP100), stress/chemical responses (APAF1, HSPD1, KLF4), and mitochondrial function (CISD1, MTHFD2, SQOR) was upregulated in HIV+ non-smokers and further increased in HIV+ smokers. Gene expression changes associated with smoking in previous studies of human monocytes were also observed (SASH1, STAB1, PID1, MMP25). Depressive symptoms (CES-D scores ≥ 16) were more prevalent in HIV+ tobacco smokers compared with HIV+ and HIV− non-smokers (50% vs. 26% and 13%, respectively; p = 0.007), and upregulation of immune/interferon response genes, including IFI35, IFNAR1, OAS1-2, STAT1, and SP100, was associated with depressive symptoms in logistic regression models adjusted for HIV status and smoking (p < 0.05). Network models linked the Stat1-mediated interferon pathway to transcriptional regulator Klf4 and smoking-associated toll-like receptor scaffolding protein Sash1, suggesting inter-relationships between smoking-associated genes, control of monocyte differentiation, and interferon-mediated inflammatory responses. Conclusions This study characterizes immune, interferon, stress response, and mitochondrial-associated gene expression changes in monocytes from HIV+ tobacco smokers, and identifies augmented interferon and stress responses associated with depressive symptoms. These findings help to explain complex interrelationships between pro-inflammatory effects of HIV and smoking, and their combined impact on comorbidities prevalent in HIV+ individuals.
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Affiliation(s)
- David R Lorenz
- Department of Cancer Immunology and Virology, Dana-Farber Cancer Institute, Center for Life Science 1010, 450 Brookline Avenue, Boston, MA, 02215, USA
| | - Vikas Misra
- Department of Cancer Immunology and Virology, Dana-Farber Cancer Institute, Center for Life Science 1010, 450 Brookline Avenue, Boston, MA, 02215, USA
| | - Dana Gabuzda
- Department of Cancer Immunology and Virology, Dana-Farber Cancer Institute, Center for Life Science 1010, 450 Brookline Avenue, Boston, MA, 02215, USA.
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19
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Tashkin DP, Roth MD. Pulmonary effects of inhaled cannabis smoke. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2019; 45:596-609. [PMID: 31298945 DOI: 10.1080/00952990.2019.1627366] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background: The smoke generated from cannabis delivers biologically active cannabinoids and a number of combustion-derived toxins, both of which raise questions regarding the impact of cannabis smoking on lung function, airway inflammation and smoking-related lung disease.Objectives: Review the potential effects of cannabis smoking on respiratory symptoms, lung function, histologic/molecular alterations in the bronchial mucosa, smoking-related changes in alveolar macrophage function and the potential clinical impact of cannabis smoking on chronic obstructive pulmonary disease, lung cancer and pulmonary infections.Methods: Focused literature review.Results: The carcinogens and respiratory toxins in cannabis and tobacco smoke are similar but the smoking topography for cannabis results in higher per-puff exposures to inhaled tar and gases. The frequency of chronic cough, sputum and wheeze and the presence of airway mucosal inflammation, goblet cell and vascular hyperplasia, metaplasia and cellular disorganization are similar between cannabis smokers and tobacco smokers. Cannabis smoke has modest airway bronchodilator properties but of unclear clinical significance. While clear evidence exists for progression to obstructive lung disease and emphysema in chronic tobacco smokers, the effects from habitual cannabis use are less clear. Evidence suggests that alveolar macrophages from cannabis smokers have deficits in cytokine production and antimicrobial activity not present in cells from tobacco smokers.Conclusions: Solid conclusions regarding the respiratory consequences of regular cannabis smoking are difficult to make due to a relative paucity of literature, confounding by concurrent tobacco smoking and reports of conflicting outcomes. Additional well-controlled clinical studies on the pulmonary consequences of habitual cannabis use are needed.
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Affiliation(s)
- Donald P Tashkin
- Department of Medicine, Division of Pulmonary & Critical Care, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Michael D Roth
- Department of Medicine, Division of Pulmonary & Critical Care, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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20
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Wenger DS, Crothers K. Marijuana Smoking in Men with HIV Infection: A Cause for Concern. EClinicalMedicine 2019; 7:5-6. [PMID: 31193599 PMCID: PMC6537548 DOI: 10.1016/j.eclinm.2019.01.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 01/30/2019] [Indexed: 01/13/2023] Open
Affiliation(s)
- David S. Wenger
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of Washington, Seattle, WA, United States of America
| | - Kristina Crothers
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of Washington, Seattle, WA, United States of America
- Veterans Affairs Puget Sound Health Care System, Seattle, WA, United States of America
- Corresponding author at: Veterans Affairs Puget Sound Health Care Center and Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of Washington, Seattle, WA, United States of America.
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