Among People with HIV, Cigarette Smoking is Associated with Poor Antiretroviral Therapy Adherence and a Detectable Viral Load

Cigarette smoking is highly prevalent among individuals with HIV; studies have suggested a correlation between smoking and suboptimal antiretroviral therapy (ART) adherence, virologic failure independent of adherence, and mortality. Researchers used data from a primary care-based randomized controlled trial of an ART adherence intervention for patients with depression to investigate the effects of smoking on HIV outcomes in terms of health care utilization and alcohol and substance use. Fifty-seven percent of participants identified as currently smoking.

• As in prior studies, smoking was strongly associated with suboptimal ART adherence and having a detectable viral load.
• Patients who smoked attended fewer outpatient medical visits and viewed health as less important in overall quality of life.
• Individuals with unhealthy alcohol use, marijuana, cocaine, and heroin use were more likely to smoke (odds ratios, 2.87–4.75). Participants with and without smoking did not differ with respect to their low-risk use of alcohol, non-medical use of prescription opioids, or sedative use.

Comments:

The authors of this study suggest that individuals who smoke may be less concerned with their health and are therefore likely to underutilize primary care, leading to higher inpatient admission rates and mortality. They also hypothesize that concurrent illicit substance use could lead to poor ART adherence and ultimately virologic failure. Studies using more advanced epidemiologic techniques are required to establish these causal relationships. Additionally, smoking status may be a marker for other unhealthy substance use; interventions to address smoking and other substances together should be considered. As patients who smoked underutilized primary care, community-based interventions may be optimal.

Jessica S. Merlin, MD, MBA

Reference:

O’Cleirigh C, Valentine SE, 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. 2014 [Epub ahead of print]. PMID: 24770984.