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The Unique Challenges Facing HIV-Positive Patients Who Smoke Cigarettes: HIV Viremia, Art Adherence, Engagement in HIV care, and Concurrent Substance Use

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Abstract

Evidence suggests that smoking may have negative associations with HIV health outcomes. The smoking rate in our sample of people living with HIV (N = 333) was triple that of the general population (57 v. 19 %). Regression analyses revealed that (smokers v. non-smokers) reported lower medication adherence (unstandardized beta = 9.01) and were more likely to have a detectable viral load (OR = 2.85, 95 % CI [1.53–5.30]). Smokers attended fewer routine medical visits (β = −0.16) and were more likely to report recent hospitalization (OR = 1.89, 95 % CI [0.99, 3.57]). Smokers ranked “health” as less important to their quality of life (β = −0.13) and were more likely to report problematic alcohol (OR = 2.40, 95 % CI [1.35, 4.30]), cocaine (OR = 2.87, 95 % CI [1.48–5.58]), heroin (OR = 4.75, 95 % CI [1.01, 22.30]), or marijuana use (OR = 3.08, 95 % CI [1.76–5.38]). Findings underscore the need for integrated behavioral smoking cessation interventions and routine tobacco screenings in HIV primary care.

Resumen

Las pruebas indican que el fumar puede tener asociaciones negativas para la salud de personas viviendo con el VIH. La tasa de fumar en este estudio fue el triple de lo que se encuentra en la población general (57 v. 19%). Analices de regresión indicaron que para los fumadores (v. los que no fuman) la adherencia a los medicamentos era más bajo (unstandardized beta = 9.01) y la probabilidad de tener una carga viral de nivel detectable era más alto (OR = 2.85, 95 % CI [1.53-5.30]). Los fumadores asistieron a visitas medicas rutinas con menos frecuencia (β = −0.16) y tenían más probabilidad de haber sido hospitalizados recientemente (OR = 1.89, 95 % CI [0.99, 3.57]). Los fumadores también clasificaron que su “salud” tenía menos importancia para su calidad de vida (β = -0.13) y con más frecuencia notaron uso de lo siguiente: alcohol a nivel problemático (OR = 2.40, 95 % CI [1.35, 4.30]), cocaína (OR = 2.87, 95 % CI [1.48-5.58]), heroína (OR = 4.75, 95 % CI [1.01, 22.30]) o marihuana (OR = 3.08, 95 % CI [1.76–5.38]). Los resultados subrayan la necesidad de integrar dos programas dentro del cuidado médico para el VIH – pruebas para detectar los que fuman y intervenciones conductuales para el paro del fumar.

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Acknowledgments

This research was supported by the National Institute of Mental Health, grant number 5R01MH084757 awarded to Dr. Steven A. Safren.

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Authors and Affiliations

  1. Department of Psychiatry, Massachusetts General Hospital, One Bowdoin Square, 7th Floor, Boston, MA, 02114, USA

    Conall O’Cleirigh, Sarah E. Valentine, C. Andres Bedoya, Janna R. Gordon & Steven A. Safren

  2. Harvard Medical School, Boston, MA, USA

    Conall O’Cleirigh, Sarah E. Valentine, C. Andres Bedoya, Janna R. Gordon & Steven A. Safren

  3. The Fenway Institute, Boston, MA, USA

    Conall O’Cleirigh & Steven A. Safren

  4. The Miriam Hospital, Providence, RI, USA

    Megan Pinkston

  5. Butler Hospital, Providence, RI, USA

    Debra Herman

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  1. Conall O’Cleirigh
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Correspondence to Conall O’Cleirigh.

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O’Cleirigh, C., Valentine, S.E., Pinkston, M. et al. The Unique Challenges Facing HIV-Positive Patients Who Smoke Cigarettes: HIV Viremia, Art Adherence, Engagement in HIV care, and Concurrent Substance Use. AIDS Behav 19, 178–185 (2015). https://doi.org/10.1007/s10461-014-0762-7

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