#67 Notable Clinical Interest
Emerging findings or policy developments worth monitoring closely.
Clinicians treating HIV-positive patients need to assess cannabis use as a modifiable fall risk factor, particularly important given that HIV-related peripheral neuropathy and antiretroviral medications already increase fall vulnerability. Falls in this population can lead to serious complications including fractures and hospitalization, making cannabis counseling a practical safety intervention during routine care. Providers should document cannabis use in fall risk assessments and discuss alternatives with patients to reduce injury risk.
The HAILO study, conducted across 32 U.S. clinical research sites, investigated the relationship between cannabis use and fall risk in adults living with HIV. Given that falls represent a significant cause of morbidity and mortality in this population, and that HIV itself impairs balance and increases fall susceptibility through effects on the nervous system, understanding cannabis as an additional risk factor is clinically important. The study findings suggest that cannabis use may further elevate fall risk in people with HIV, potentially through cannabinoid effects on motor coordination, proprioception, and balance mechanisms. This association has direct implications for patient counseling and management, particularly since many HIV patients may use cannabis for symptom management or pain control. Clinicians caring for people with HIV should assess cannabis use as part of routine fall risk evaluation and discuss these risks with patients considering or currently using cannabis, while exploring alternative symptom management strategies when appropriate.
“The early signals here are worth watching, particularly in this vulnerable population, but we’re still working with limited data on the mechanism and magnitude of risk. What I tell my HIV-positive patients is that if they use cannabis, we need to have an explicit conversation about fall prevention and balance assessment, since we know both HIV itself and cannabis can independently affect proprioception and stability.”
🚨 This emerging evidence linking cannabis use to increased fall risk in people with HIV adds an important safety consideration to our counseling discussions, particularly given the high prevalence of cannabis use in this population and the already-elevated fall risk from antiretroviral medications, neuropathy, and bone health complications. While the HAILO study provides valuable data from multiple clinical sites, clinicians should recognize that cannabis use patterns, frequency, and individual metabolic factors vary considerably, and causality cannot be definitively established from observational data alone. The mechanism may involve cannabis effects on balance and proprioception, potential drug-drug interactions with antiretrovirals, or confounding by unmeasured factors affecting both cannabis use and fall propensity. When counseling people with HIV, particularly older adults or those with existing balance impairment, it would be prudent to specifically ask about cannabis use and discuss fall prevention strategies, while acknowledging that some patients may use cannabis
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