#67 Notable Clinical Interest
Emerging findings or policy developments worth monitoring closely.
Clinicians caring for adults with HIV should assess cannabis use as a modifiable risk factor for falls, which can lead to serious injuries and complications in an already vulnerable population. This finding is particularly important given that cannabis use is increasingly common and often perceived as safe, yet may interact with antiretroviral medications or HIV-related symptoms to impair balance and coordination. Patients with HIV who use cannabis should receive counseling about fall prevention strategies and discussion of safer alternatives if balance or mobility concerns are present.
A multicenter prospective cohort study (HAILO) conducted across 32 U.S. clinical research sites examined fall risk in adults with HIV who use cannabis, finding that cannabis use was associated with increased fall incidence in this population. Falls represent a significant clinical concern in HIV-positive individuals due to potential complications from immunosuppression, medication interactions, and underlying comorbidities, making additional risk factors particularly relevant. The mechanism likely involves cannabis-related effects on balance, proprioception, and cognition, which may be compounded by antiretroviral medications and HIV-related neuropathy that already compromise motor function in this population. For clinicians caring for HIV patients, this finding suggests the need to screen for cannabis use during fall risk assessments and to counsel patients about this potential hazard, particularly those with existing balance impairment or polyneuropathy. Patients with HIV who use cannabis should be counseled about fall prevention strategies and clinicians should consider this risk when discussing cannabis use in the context of their overall safety profile.
“This observational data from HAILO raises a legitimate clinical signal we should take seriously, though I’d want to see this replicated in prospective studies before making definitive recommendations, since observational designs can’t fully account for confounding factors like medication interactions or underlying neuropathy that might independently increase fall risk in this population.”
🔴 Clinicians caring for adults with HIV should be aware that cannabis use may represent an additional, modifiable risk factor for falls in this population, who already face elevated fall risk from antiretroviral side effects, neuropathy, and immune reconstitution complications. The HAILO study provides useful observational data, though the mechanism linking cannabis to falls in HIV-positive patients remains incompletely characterized; confounders such as concurrent substance use, medication interactions, degree of immunosuppression, and the specific cannabinoid profile consumed warrant careful consideration in individual assessments. Falls carry substantial morbidity in people with HIV, potentially accelerating frailty and complicating medication adherence, making fall prevention a legitimate clinical concern. When discussing cannabis use during routine visits, providers should explicitly screen for fall risk and counsel patients about this potential hazard, particularly those with documented neuropathy, balance disorders, or polypharmacy; documenting such
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