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Smoking Rate Twice Higher With Than Without HIV in First National US Study
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20th Conference on Retroviruses and Opportunistic Infections, March 3-6, 2013, Atlanta
Mark Mascolini
"after treatment for HIV, smoking cessation efforts should be prioritized for HIV-infected persons in care."
Smoking prevalence in HIV-positive people in care doubles the rate in the general population, according to analysis of the first nationally representative sample of HIV-positive adults in a US smoking study [1]. Centers for Disease Control and Prevention (CDC) researchers calculated that 42% of HIV-positive US residents in care smoke.
High smoking rates among HIV-positive people are an established phenomenon, and dozens of studies link smoking to higher risk of cardiovascular disease and certain cancers in people with HIV. But until this analysis within the CDC's Medical Monitoring Project, no one had a good estimate of the proportion of HIV-positive smokers compared with the general population.
CDC investigators conducted a nationally representative interview survey of HIV-positive people in care in Puerto Rico and 16 states--New York, New Jersey, Pennsylvania, Delaware, Virginia, North Carolina, Georgia, Florida, Mississippi, Texas, Michigan, Indiana, Illinois, Washington, Oregon, and California. They compared smoking rates and risk factors in this Medical Monitoring Project cohort of 4217 people and a general-population sample of 27,731 adults in the National Health Interview Survey. Both surveys were conducted in 2009.
The CDC team defined smokers the same way in both surveys: Current smokers had smoked at least 100 cigarettes over their lifetime and currently smoked at least some days. Former smokers had smoked at least 100 cigarettes in their lifetime but did not currently smoke. Never smokers were people who smoked fewer than 100 cigarettes in their lifetime.
Of the 4217 HIV-positive people in care, 1781 (42%) were current smokers, while 21% in the general US population smoked. Proportions of former smokers were 20% in the HIV group and 22% in the general population, while respective proportions of never smokers were 37% and 58%.
Among current smokers with HIV, there were 993 people 45 to 64 years old (56.7%), 725 people 25- to 44-years old (39.7%), 34 people 18 to 24 (1.8%), and 29 people 65 or older (1.4%). Men made up a higher proportion of the current-smoker group (72.1%) than women (26.6%) or transgenders (1.3%), and blacks made up a larger proportion (42.8%) than whites (35.8%), Hispanics (15.9%), or others (4.5%).
By sexual orientation, heterosexuals made up the largest proportion of current smokers in the HIV group (51.3%), followed by gays and lesbians (38.6%) and bisexuals (8.8%). People with more than a high-school education made up a higher proportion of current HIV-positive smokers (42.1%) than people with a high-school education (30.3%) or people with less than a high-school education (27.6%). About half of current HIV-positive smokers lived above the poverty level and half below the poverty level.
In an unadjusted analysis, smoking prevalence was 2.1 times higher in HIV-positive people than in the general US population. After adjustment for age only, the standardized prevalence ratio comparing HIV-positives to the general population remained similar at 1.9. That prevalence ratio remained largely unaffected by individual adjustments for gender (1.9), race/ethnicity (2.1), education level (2.0), and poverty level (1.7).
The CDC investigators stressed that results from the Medical Monitoring Project do not reflect smoking rates in HIV-positive people not in care, including those who do not know they are infected. They also cautioned that smoking rates in this analysis rely on self-report without biochemical test confirmation.
Because of the high smoking prevalence in people with HIV, the CDC argued that "after treatment for HIV, smoking cessation efforts should be prioritized for HIV-infected persons in care." They advise clinicians to rely on evidence-based smoking cessation strategies for people with HIV.
Reference
1. Mdodo R, Frazier E, Mattson C, Sutton M, Brooks J, Skarbinski J. Cigarette smoking among HIV+ adults in care: Medical Monitoring Project, US, 2009. 20th Conference on Retroviruses and Opportunistic Infections. March 3-6, 2013. Atlanta. Abstract 775.
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