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To examine prevalence and patterns of smoked marijuana and perceived benefit and to assess demographic and clinical factors associated with marijuana use among HIV patients in a public health care setting.Participants (n = 252) were recruited via consecutive sampling in public health care clinics. Structured interviews assessed patterns of recent marijuana use, including its perceived benefit for symptom relief. Associations between marijuana use and demographic and clinical variables were examined using univariate and multivariate regression analyses.Overall prevalence of smoked marijuana in the previous month was 23%. Reported benefits included relief of anxiety and/or depression (57%), improved appetite (53%), increased pleasure (33%), and relief of pain (28%). Recent use of marijuana was positively associated with severe nausea (odds ratio [OR] = 4.0, P = 0.004) and recent use of alcohol (OR = 7.5, P < 0.001) and negatively associated with being Latino (OR = 0.07, P < 0.001). No associations between marijuana use and pain symptoms were observed.The findings suggest that providers be advised to assess routinely and better understand patients' “indications” for self-administration of cannabis. Given the estimated prevalence, more formal characterization of the patterns and impact of cannabis use to alleviate HIV-associated symptoms is warranted. Clinical trials of smoked and noncombustible marijuana are needed to determine the role of cannabinoids as a class of agents with potential to improve quality of life and health care outcomes among patients with HIV/AIDS.