Baseline Cigarette Smoking Status as a Predictor of Virologic Suppression and CD4 Cell Count During One-Year Follow-Up in Substance Users with Uncontrolled HIV Infection
Cigarette smoking is prevalent in people living with HIV/AIDS (PLHIV) who abuse alcohol and/or illicit substances. This study evaluated whether smoking is predictive of virologic non-suppression (> 200 copies/mL) and low CD4 count (< 200 cells/mm3) during 1-year follow-up in medically hospitalized, substance-using PLHIV recruited for a multi-site trial. Smoking status was assessed with the Heaviness of Smoking Index (HSI). Analyses revealed that, controlling for baseline differences and adherence to antiretroviral therapy, non-smokers (n = 237), compared to smokers scoring in the medium-to-high range on the HSI (n = 386), were significantly more likely to achieve viral suppression (OR 1.50, 95% CI 1.02, 2.20). There was a significant smoking-by-time interaction for CD4 cell count (χ2(1) = 4.08, p < .05), with smokers less likely to have low CD4 count at baseline and 6-month follow-up, but more likely to have low CD4 count at 12-month follow-up. The results suggest that smoking may play a role in immunological functioning in HIV-infected substance users. ClinicalTrials.gov Identifier: NCT01612169.
KeywordsTobacco HIV Substance abuse Virologic suppression
Funding for the parent trial and analysis was provided for the study’s principal investigators by the National Institute on Drug Abuse under the following awards: U10DA013720 and UG1DA013720 (Drs. José Szapocznik and Lisa R. Metsch); U10DA013035 and UG1DA013035 (Drs. John Rotrosen and Edward V. Nunes, Jr.); U10DA013034 and UG1DA013034 (Drs. Maxine Stitzer and Robert Schwartz); U10DA013727 and UG1DA013727 (Drs. Kathleen T. Brady and Matthew Carpenter); U10DA020024 and UG1DA020024 (Dr. Madhukar H. Trivedi); U10DA013732, UG1DA013732, and 5UG1DA013732 (Dr. Theresa Winhusen); U10DA015831 and UG1DA015831 (Drs. Roger D. Weiss and Kathleen Carroll); U10DA015815 and UG1DA015815 (Drs. James L. Sorensen and Dennis McCarty); U10DA020036 (Dr. Dennis Daley); U10DA013043 (Dr. George Woody); U10DA013045 (Dr. Walter Ling); HHSN271200900034C/N01DA92217 and HHSN271201400028C/N01DA142237 (Dr. Paul VanVeldhuisen); and HHSN271201000024C/N01DA102221 (Dr. Robert Lindblad). Support from the University of Miami Center for AIDS Research (CFAR) (P30AI073961; Dr. Savita Pahwa), the Emory University CFAR (P30AI050409; Drs. Carlos del Rio, James W. Curran, and Eric Hunter), the Atlanta Clinical and Translational Science Institute (UL1TR000454; Dr. David Stephens), and the HIV Center for Clinical and Behavioral Studies at the New York State Psychiatric Institute/Columbia University Medical Center (P30MH043520; Dr. Robert Remien) is also acknowledged. The National Institute on Drug Abuse (NIDA) had no further role in study design or in the collection, analysis and interpretation of data. NIDA Center for the Clinical Trials Network (CCTN) personnel contributed to the design of the original study and CCTN contractors played a role in the collection and analysis of data from the original study. NIDA had no further role in the design of this analysis, in the manuscript writing of the report, or in the decision to submit the paper for publication.
Compliance with Ethical Standards
Conflict of interest
The authors declare that they have no conflict of interest.
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.
Informed consent was obtained from all individual participants included in the study.
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