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Association of Cannabis Use With Risk of Subsequent Falls Among Adults Aging With HIV
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11 August 2026
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Download the PDF here
We observed that current cannabis use was moderately associated with fall risk, although this association was not maintained when adjusted for additional fall risk factors including cigarette smoking status, previous falls, other psychoactive substance use, prescribed psychotropic medication use, heavy alcohol use, and peripheral neuropathy, suggesting that these other factors may have a greater influence than cannabis use on fall risk.
Among these other factors, cigarette smoking status was an important risk factor that appeared to be the strongest predictive variable leading to the attenuation of the association of fall risk with cannabis use. Given that cannabis use is highly prevalent among PWH [16], that falls are a significant cause of mortality and morbidity [11], and that people who use cannabis are also more likely to use cigarettes, identifying the co-occurrence of cigarette and cannabis use may assist in the risk stratification of PWH who are aging, as these individuals may be at higher risk of experiencing falls.
future interventional studies are needed to determine whether reduction or cessation of cigarette smoking and/or cannabis use can effectively decrease fall incidence, an outcome that would complement the well-known benefits of smoking cessation, among PWH. Future studies should also examine whether specific parameters of cannabis use (eg, composition, dose, and frequency) influence fall risk and whether lower-risk patterns of use can be defined for aging PWH.
People who use cigarettes are more likely to have additional comorbidities (eg, diabetes, hypertension, and cardiovascular disease) that require additional medications, with both multimorbidity and polypharmacy increasing the fall risk. Cigarette smoking associates with elevated inflammation among ART-treated PWH [35, 36], and elevated inflammation associates with frailty and function impairments in PWH [37, 38], an additional risk factor for falls among PWH. In contrast, cannabis use associates with lower inflammation among PWH [26, 39]. Thus, our findings could indicate that the modest anti-inflammatory effects of cannabis are not sufficient to overcome the influence of cigarette smoking and associated increased risk for falls. Additional research is needed to determine how cannabis use, cigarette smoking, inflammation, and physical function intersect, particularly among older PWH.
Abstract
Background
Potential harms of preventable/modifiable use of substances, such as cannabis, among aging people with HIV (PWH) are unclear. We characterized longitudinal associations between current cannabis use and subsequent fall risk among aging PWH.
Method
Participants in the Advancing Clinical Therapeutics Globally (ACTG) A5322 study self-reported current cannabis use and any fall(s) annually and semiannually, respectively. Generalized linear models and inverse probability weighting were used to assess associations between cannabis use and subsequent fall risk, adjusting for baseline covariates (age, sex assigned at birth, and race/ethnicity), time-varying confounders, and study attrition.
Results
Among 957 participants (median age, 51 years), 18.2% reported current cannabis use at baseline; 18.6% reported falling in the first year of the longitudinal study. Current cannabis use was associated with moderate risk of any falls in the following year in baseline covariate-adjusted analysis (risk ratio [RR], 1.27 95% CI, 1.02, 1.57; P = .029), but not in analyses additionally adjusted for fall history, nonprescribed psychoactive substance use, psychotropic and analgesic medication use, heavy alcohol use, peripheral neuropathy, and cigarette smoking status (adjusted RR, 1.11 [95% CI, .83, 1.49]; P = .49). Cigarette smoking status was the main variable that attenuated the association between falls and cannabis use.
Conclusions
Among aging PWH, the association between current cannabis use and fall risk was primarily confounded by cigarette smoking status. Future studies should incorporate more granular cannabis use data on falls risk, including cannabis composition or strain and dose.
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