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Cigarette Smoking and Substance Use Each Independently Cuts Chances of HIV Control
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AIDS 2020: 23rd International AIDS Conference Virtual, July 6-10, 2020
Mark Mascolini
Self-reported current cigarette smoking independently cut chances of keeping HIV load below 200 copies in a study of 227 Los Angeles men [1]. Current substance use, excluding marijuana, independently sliced chances of HIV control about 55%.
In the United States and many other countries, people with HIV smoke cigarettes substantially more often than the general population. A 2009-2014 US longitudinal comparison of smokers with HIV and the general population found that smoking prevalence in the HIV group remained stagnant at around 35% for most of the study period, while the smoking rate in the general population dwindled from about 20% to 17% [2]. Quit ratios also proved much lower in people with HIV. A US comparison of 1163 people with HIV and 294 HIV-negative controls determined that 86% versus 67% reported ever using illicit drugs (P < 0.0001), while 28% versus 16% reported current use (P = 0.0001) [3].
A group at the University of California, Los Angeles (UCLA) recently reported preliminary results of the mSTUDY involving 155 HIV-positive men of color who have sex with men (MoCSM) [4]. They linked cigarette smoking and biological markers of recent drug use to a significantly higher chance of a detectable viral load. In contrast, men with psychiatric illness proved more likely to maintain an undetectable load.
The new UCLA study involved 227 men prescribed antiretroviral therapy from 2014 to 2019. The researchers assessed independent and joint effects of time-varying smoking (at least 1 cigarette daily) and substance use (opiates, fentanyl, cocaine, amphetamine-type stimulants, or nitrites-but not cannabis) on viral suppression, defined as a viral load below 200 copies, at each 6-month follow-up visit. They assessed the impact of these behaviors with a mixed-effects logistic regression model accounting for repeated measures and adjusted for time, age, race/ethnicity, employment, and history of psychiatric illness.
These 227 men had a median age of 34 (interquartile range 29 to 39), 39% were Black, 39% were employed or a full-time student, 70% had a psychiatric history, and 72% had viral suppression. Median age was similar across three subgroups:
Group 1: No drug use and either smoking or no smoking (n = 46)
Group 2: Drug use and no smoking (n = 74)
Group 3: Both smoking and drug use (n = 107)
Blacks made up 52% of group 1, 28% of group 2, and 40% of group 3. Workers/students represented a higher proportion of group 1 (63%) than of group 2 (46%) or group 3 (31%). Most men had a psychiatric history, but psychiatric illness proved less frequent in group 1 (57%), than group 2 (64%) or group 3 (80%). Viral suppression rates were similar across groups: 72% in group 1, 78% in group 2, and 68% in group 3.
An analysis adjusted for age, race, employment, psychiatric history, and time determined that smoking lowered odds of viral suppression about 40% (adjusted odds ratio [aOR] 0.59, 95% confidence interval [CI] 0.36 to 0.97). Substance use had an even greater impact, curbing odds of viral suppression about 55% (aOR 0.46, 95% CI 0.28 to 0.74). The interaction between smoking and substance use did not have a statistically significant impact on viral suppression.
Almost 100 smokers in this group also used methamphetamine, while about 50 nonsmokers used meth. Approximate numbers of smokers and nonsmokers who used opiates were 30 and 25, and numbers who used cocaine were about 40 and 20.
The UCLA collaborators cautioned that their analysis did not weigh the impact of smoking or substance use intensity and that they relied on self-report of both behaviors. These findings, they added, may not apply to other HIV populations.
The researchers concluded that "reported cigarette smoking and substance use other than cannabis each independently reduced the odds of experiencing viral suppression at each 6-month visit." Their ongoing work will focus on the cumulative effects of smoking and substance use on viral suppression over time in this population.
References
1. Kalmin MM, Aralis HJ, Li MJ, Javanbakht M, Gorbach PM, Shoptaw S. Effects of cigarette smoking and substance use on HIV viral suppression over time in a cohort of young men who have sex with men. AIDS 2020: 23rd International AIDS Conference Virtual. July 6-10, 2020. Abstract OAD0404.
2. Frazier EL, Sutton MY, Brooks JT, Shouse RL, Weiser J. Trends in cigarette smoking among adults with HIV compared with the general adult population, United States - 2009-2014. Preventive Medicine. 2018;22:357-365. doi: 10.1016/j.ypmed.2018.03.007.
3. Cofrancesco J, Scherzer R, Tien PC, Gibert CL, Southwell H, Sidney S, Dobs A, Grunfeld C. Illicit drug use and HIV treatment outcomes in a US cohort. AIDS. 2008;22:357-365. doi: 10.1097/QAD.0b013e3282f3cc21.
4. Aralis HJ, Shoptaw S, Brookmeyer R, Ragsdale A, Bolan R, Gorbach PM. Psychiatric illness, substance use, and viral suppression among HIV-positive men of color who have sex with men in Los Angeles. AIDS Behav. 2018;22:3117-3129.
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