Association of Marijuana, Tobacco, and Alcohol Use With Estimated Glomerular Filtration Rate in Women Living With HIV and Women Without HIV

Author Type(s)

Faculty

Document Type

Abstract

Publication Date

2022

Journal Title

Journal of the American Society of Nephrology

Department

Public Health

Abstract

Background: Marijuana, tobacco and alcohol use are behavioral risk factors for impaired kidney function, which have not been thoroughly evaluated in persons living with HIV (PLWH). We evaluated associations between use of these substances with estimated glomerular filtration rate (eGFR) among women living with HIV (WLWH) and women without HIV. Methods: We undertook a repeated measures cross-sectional study of WLWH and women without HIV nested within the Women's Interagency HIV Study, a multicenter, prospective women's cohort in the United States. Substance use was ascertained using semi-annual questionnaires. Multivariable linear regression adjusting for sociodemographic, chronic kidney disease risk factors and HIV-related factors were used to assess associations of current and cumulative marijuana, tobacco and alcohol exposures with eGFR between 2009 and 2019. Results: Among 1512 participants, 1043 were WLWH with 14,481 study visits and 469 were women without HIV with 6,660 study visits. At baseline, WLWH had a lower median eGFR (99.8 mL/min/1.73m2 (IQR 80.9-114) vs 102.7 mL/min/1.73m2 (IQR 88.4-116.2), p=0.003), lower prevalence of current marijuana use (14% vs 22%, p<0.0001), lower current alcohol use (39% vs 50%, p<0.0001) and trend toward lower current tobacco use (40% vs 46%, p=0.06) compared to women without HIV. Alcohol use of >7 drinks/week compared with no use was associated with a 3.95 mL/min/1.73m2 (95% confidence interval 1.03, 6.86; p=0.008) higher eGFR. Neither current marijuana use versus no use nor 10-year cumulative use of >1.6 versus 0-0.02 marijuana-years were associated with eGFR. Current tobacco use compared to never use and lifetime tobacco use of >10 compared to 0 pack-years were also not associated with eGFR. Conclusions: In a large cohort of WLWH and women without HIV, heavy alcohol use was associated with a higher eGFR and there was no association of marijuana or tobacco use with eGFR. Despite lack of evidence of harmful effects on kidney function from marijuana and tobacco use, clinical care of PLWH should include substance use screening and counseling on other known health risks associated with substance use.

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