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Tobacco Use and Sustained Viral Suppression in Youth Living with HIV


Tobacco has been associated with worse HIV disease progression in adult samples of people living with HIV; however, studies have yet to examine these effects in youth living with HIV (YLWH). This study examined the association between tobacco smoking behaviors and sustained viral suppression among a sample of 820 YLWH who were recruited through the Adolescent Medicine Trials Network for HIV Interventions. Participants completed a cross-sectional survey and then staff abstracted viral suppression data from medical records for up to 26 weeks prior to enrollment. Overall, 20.4% of youth reported daily or almost daily tobacco use. In multivariable analyses, older age and daily or almost daily tobacco smoking, and ART adherence remained statistically significant in predicting sustained viral suppression over the study period. These findings underscore the need for tobacco screening and interventions in HIV care settings in order to identify youth in need of additional smoking cessation services.


El tabaco se ha asociado con una progresión peor de la enfermedad del VIH en muestras adultas de personas que viven con el VIH; sin embargo, los estudios todavía tienen que examinar estos efectos en los jóvenes que viven con el VIH (YLWH). Este estudio examinó la asociación entre los hábitos de fumar tabaco y la supresión viral sostenida entre una muestra de 820 YLWH que fueron reclutados a través de la Red de Investigación de Medicina del Adolescente para Intervenciones de VIH. Los participantes completaron una encuesta transversal y luego el personal extrajo los datos de supresión viral de los registros médicos hasta 26 semanas antes de la inscripción. En general, el 20,4% de los jóvenes informó un consumo diario o casi diario de tabaco. En los análisis multivariables, la edad avanzada y el tabaquismo diario o casi diario, y la adherencia a la terapia antirretroviral permanecieron estadísticamente significativas en la predicción de la supresión viral sostenida durante el período del estudio. Estos hallazgos subrayan la necesidad de evaluación del uso de tabaco e intervenciones en entornos de atención del VIH con el fin de identificar a los jóvenes que necesitan servicios adicionales para dejar de fumar.

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Clinics were located in the following locations: Los Angeles, California; Washington, DC; Baltimore, Maryland; Boston, Massachusetts; Chicago, Illinois; Philadelphia, Pennsylvania; New York City, New York; New Orleans, Louisiana; Memphis, Tennessee; Miami, Florida; Tampa, Florida; Detroit, Michigan; Denver, Colorado; and Houston, Texas. This research was supported by The Adolescent Medicine Trials Network for HIV/AIDS Interventions (ATN) from the National Institutes of Health [U01HD040533 and U01HD040474] through the National Institute of Child Health and Human Development (Kapogiannis, Lee), with supplemental funding from the National Institutes on Drug Abuse (Davenny, Kahana) and Mental Health (Brouwers, Allison). Support was also provided to the first author by the Providence/Boston Center for AIDS Research (P30AI042853, PI: Cu-Uvin). The study was scientifically reviewed by the ATN’s Behavioral Leadership Group. Network, scientific and logistical support was provided by the ATN Coordinating Center (Wilson, Partlow) at the University of Alabama at Birmingham. Network operations and data management support was provided by the ATN Data and Operations center at Westat, Inc. (Korelitz, Driver). We acknowledge the contribution of the investigators and staff at the following sites that participated in this study: University of South Florida, Tampa (Emmanuel, Lujan-Zilbermann, Julian), Children’s Hospital of Los Angeles (Belzer, Flores, Tucker), Children’s National Medical Center (D’Angelo, Hagler, Trexler), Children’s Hospital of Philadelphia (Douglas, Tanney, DiBenedetto), John H. Stroger Jr. Hospital of Cook County and the Ruth M. Rothstein CORE Center (Martinez, Bojan, Jackson), Montefiore Medical Center (Futterman, Enriquez-Bruce, Campos), Tulane University Health Sciences Center (Abdalian, Kozina, Baker), University of Miami School of Medicine (Friedman, Maturo, Major-Wilson), St. Jude’s Children’s Research Hospital (Flynn, Dillard), Baylor College of Medicine (Paul, Calles, Cooper), Wayne State University (Secord, Cromer, Green-Jones), Johns Hopkins University School of Medicine (Agwu, Anderson, Park), The Fenway Institute—Boston (Mayer, George, Dormitzer), and University of Colorado, Denver (Reirden, Hahn, Witte). We are greatly appreciative to all of the adolescents and young adults who participated in this study. Funding was provided by National Institute on Alcohol Abuse and Alcoholism (Grant No. U24AA022000).

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Correspondence to Kristi E. Gamarel.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Gamarel, K.E., Westfall, A.O., Lally, M.A. et al. Tobacco Use and Sustained Viral Suppression in Youth Living with HIV. AIDS Behav 22, 2018–2025 (2018).

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  • Tobacco use
  • HIV disease progression
  • Youth