“Treatment-related reductions in morbidity and mortality among human immunodeficiency virus (HIV)-positive patients have been attenuated by cigarette smoking, which increases risk of cardiovascular, respiratory, and neoplastic diseases. Our study investigates factors associated with smoking status among HIV-positive patients,” says Dr. Cosmas M. Zyambo, a PhD student in the department of epidemiology at the University of Alabama at Birmingham. UAB co-investigators are department colleagues Dr. Craig M. Wilson, professor, and Dr. April P. Carson, assistant professor; Mr. Andrew O. Westfall, data base analyst in department of biostatistics; Dr. Karen L. Cropsey, associate professor in the department of psychiatry; as well as Drs. Ashutosh R. Tamhane, James H. Willig, and Greer A. Burkholder in the division of infectious diseases.
In the cross-sectional study of 2,464 HIV-positive patients attending the HIV Clinic at the University of Alabama at Birmingham between April 2008 and December 2013, the researchers assessed participants’ smoking status (in the categories “current,” “former,” and “never”), psychosocial factors, and clinical characteristics. The team used multinomial logistic regression to ascertain unadjusted and adjusted odds ratios (OR) and 95 percent confidence intervals (CI) for the association between the various factors and smoking status.
The majority of the HIV-positive patients — with a mean age of 45 years, of which 75 percent were male and 55 percent were African-American — indicated a history of smoking (39 percent current smokers; 22 percent former smokers). Dr. Zyambo explains, “Among HIV-positive patients (mean age 45 years, 75 percent male, 55 percent African-American), the majority reported a history of smoking (39 percent current and 22 percent former smokers). In adjusted models, patient characteristics associated with increased odds of current smoking were male gender (OR for heterosexual men, 1.8 [95 percent CI: 1.3-2.6]; for men who have sex with men, 1.5 [1.1-1.9]), history of respiratory diseases (1.5 [1.2-1.9]), unsuppressed HIV viral load (more than 50 copies/mL) (1.5 [1.1-1.9]), depression (1.6 [1.3-2.0]), anxiety (1.6 [1.2-2.1]), and prior and current substance abuse (4.7 [3.6-6.1] and 8.3 [5.3-13.3] respectively). Male gender, anxiety, and substance abuse were also associated with being a former smoker.”
A major conclusion drawn from the study is that smoking was widespread among HIV-positive patients, with a number of psychosocial factors related to current and former smoking. This finding suggests that smoking cessation programs in HIV clinic settings may have more impact if integrated interventions also address illicit substance abuse and mental health.
“Factors Associated With Smoking Status among HIV-Positive Patients in Routine Clinical Care” was published in July in the Journal of AIDS & Clinical Research.