Cannabis use has substantially increased over the past decade, especially in people with HIV (PWH). Evidence suggests that the cannabidiol (CBD) component of cannabis, has anti-inflammatory and anti-oxidant properties that are beneficial to the cardiovascular health. However, other evidence indicates that tetrahydrocannabinol (THC), the psychoactive cannabis compound, is associated with elevated cardiovascular disease (CVD) events. In PWH, cannabis use is mostly self-prescribed to help manage comorbidities, and mitigate adverse side effects associated with antiretroviral therapy (ART). Because the extent to which cannabis use presents additional CVD risk in PWH is unclear, the proposed project is designed to examine this question, while minimizing and/or controlling for systematic bias due to HIV disease severity, antiretroviral medication regimen, systemic comorbidities and substance abuse. Our preliminary results indicate that cannabis use compared with nonusers is associated with lower central adiposity, and metabolic and cholesterol risk. In addition, lower blood pressure and aortic arterial stiffness were observed in PWH cannabis users. Although combustible cannabis products, some of which contain tobacco, are used by 90% or more users, studies of cannabis administration route and cardiovascular health are scant. Indeed, none have evaluated whether cannabis use with tobacco compared with cannabis use alone is associated with differences in CVD risk. Because the principal cannabis components may differ in their influence on CVD risk, our strategy is to examine THC/CBD concentration to help disentangle the linkage of cannabis administration route with CVD risk in PWH. The proposed study will collect complete data on 300 PWH, aged 18-60 years, to assess the linkage of cannabis use, route of administration and THC/CBD content with measures of CVD risk including 1) traditional CVD risk (central adiposity, blood pressure, fasting lipid profile, insulin resistance, and CRP; 2) aortic, femoral and radial arterial stiffness and 3) cardiac magnetic resonance to asses subclinical CVD. The study design employs strict eligibility criteria and statistical control for potentially confounding factors including demographic, cardiometabolic comorbidities, HIV-related factors, and substance abuse. The proposed research is highly significant and timely, given the accessibility of cannabis, the prevalence of use in PWH, and the uncertainty regarding CVD health-related consequences of use. The PI is an interventional cardiologist and physician scientist focused on HIV and CVD prevention, the Avenir Award would provide the opportunity to advance knowledge in the field of drug use, HIV and CVD to transform current concepts that guide recommendations regarding the use of cannabis in PWH.

PROJECT NARRATIVE Cannabis use has increased specially among people with HIV. It is not known if cannabis is associated with higher chances of heart disease or if it has a protective effect in people with HIV. As such, the purpose of this study is to understand how cannabis can affect heart disease in people with HIV to help develop strategies to decrease heart disease in this population.