Despite significant advances in antiretroviral therapy (ART), sustained adherence to ART remains critical to the long-term management of HIV infection. For persons living with HIV (PLWH), adherence to ART is key to the prevention of drug resistance, the emergence of opportunistic infections, disease progression, and death. Gay, bisexual, and other men who have sex with men (MSM) remain the group with the highest incidence and prevalence of HIV in the US and understanding barriers to ART adherence in this population is critical.
[Photo: Dr. Patricia Cioe]
Active substance use has been associated with imperfect ART adherence. In addition to alcohol and other substance use, cigarette smoking is highly prevalent among PLWH and, in particular among MSM. Smoking has been associated with increased health risks among PLWH and smoking may be related to increased viral load and progression of HIV disease. While some studies have shown that smokers have a higher prevalence of detectable HIV viral load, overall, research in this area has provided mixed results with regard to the association between cigarette smoking and ART adherence and there remain open questions about the associations between smoking and HIV medication adherence.
This study, by Dr. Patricia Cioe, Assistant Professor of Behavioral and Social Sciences in the Brown University School of Public Health and colleagues, sought to examine: (1) the socio-demographic characteristics of cigarette smokers in a sample of heavy episodic drinking HIV-infected MSM, (2) the correlates of current smoking, and, (3) whether cigarette smoking was independently associated with less than perfect adherence among MSM.
In multivariable regression analyses, only lower education was significantly associated with imperfect adherence. Although smoking was not significantly associated with imperfect adherence in multivariable analyses, the smokers in this sample had several prognostic indicators for imperfect adherence. Identifying smokers in HIV clinical practice may be one method of targeting patients who may be at risk for imperfect adherence. The greatest risk factor for smoking and imperfect ART adherence was low socioeconomic status, in which MSM of color were over-represented. Thus, addressing social and structural factors, including universal access to ART and substance use/mental health treatment, are necessary to reduce smoking and other health care disparities to improve the health condition of all persons living with HIV. As the first study to examine smoking and ART adherence in this population, this study has the potential to inform the clinical care provided to heavy-drinking MSM.
This study was published in AIDS and Behavior in July.