Association between cannabis use disorder and greater apathy in adults with HIV

Background: Apathy is prevalent among people with HIV (PWH) and is associated with poor clinical outcomes. Cannabis use and Cannabis Use Disorder (CUD) are also disproportionately prevalent among PWH. CUD and younger onset of cannabis use may be linked to apathy in the general population; however, patterns of use most strongly associated with apathy have not been firmly established, and it is unclear whether cannabis use is linked to apathy in PWH. Methods: We examined associations in 311 adult PWH between Apathy Evaluation Scale -Self (AES-S) scores and CUD history (current/past/no CUD/no cannabis use) and between AES-S scores and age of CUD onset (adolescent-onset/adult-onset). We also examined robustness of associations to adjustment for depressive symptoms (which may overlap with apathy symptoms) and alcohol use. Results: Current CUD was associated with greater AES-S scores relative to cannabis users with no CUD history (beta = 2.13, 95 % CI = 0.37-3.90, p = 0.018). Adolescent -onset CUD was not associated with greater apathy relative to adult -onset CUD (beta = 0.56, 95 % CI = -2.57 - 3.68, p = 0.7). Associations became nonsignificant after adjustment for depressive symptoms, but not after adjustment for alcohol use. Alcohol use was correlated with apathy (r = 0.19, 95 % CI: 0.076-0.29, p = 0.001). Conclusions: Cannabis Use Disorder and at -risk alcohol use are associated with apathy among PWH; this finding highlights the need for substance use disorder prevention and treatment among PWH.