HIV and smoking: associated risks and prevention strategies

Prediction of incidence of neurological disorders in HIV-infected persons in Taiwan: a nested case-control study

BACKGROUND

Neurological disorders are still prevalent in HIV-infected people. We aimed to determine the prevalence of neurological disorders and identify their risk factors in HIV-infected persons in Taiwan.

METHODS

We identified 30,101 HIV-infected people between 2002 and 2016 from the National Health Insurance Research Database in Taiwan, and analyzed the incidence of neurological disorders. We applied a retrospective, nested case-control study design. The individuals with (case group) and without (control group) a neurological disorder were then matched by age, sex and time. Factors associated with neurological disorders were analyzed using a conditional logistic regression model, and a nomogram was generated to estimate the risk of developing a neurological disorder.

RESULTS

The incidence of neurological disorders was 13.67 per 1000 person-years. The incidence remained stable during the observation period despite the use of early treatment and more tolerable modern anti-retroviral therapy. The conditional logistic regression model identified nine clinical factors and comorbidities that were associated with neurological disorders, namely age, substance use, traumatic brain injury, psychiatric illness, HIV-associated opportunistic infections, frequency of emergency department visits, cART adherence, urbanization, and monthly income. These factors were used to establish the nomogram.

CONCLUSION

Neurological disorders are still prevalent in HIV-infected people in Taiwan. To efficiently identify those at risk, we established a nomogram with nine risk factors. This nomogram could prompt clinicians to initiate further evaluations and management of neurological disorders in this population.

Sex differences in cognitive function among people with HIV-1 clade C infection in Northern India

Human immunodeficiency virus-1 (HIV-1) clade C is the most prevalent form of HIV-1 comprising nearly 46% of global infections and is the dominant subtype in India. Despite its predominance, the impact of HIV-1 clade C infection on cognitive function has been understudied in comparison with other subtypes, notably clade B, which is primarily found in Europe and North America. Few studies have assessed cognitive impairment in antiretroviral therapy (ART) naïve men and women with HIV-1 clade C infection. In this study conducted in Northern India, differences in neuropsychological functioning were compared between 109 participants (70 men, 39 women) with untreated HIV-1 clade C infection and 110 demographically matched healthy controls (74 men, 36 women). A comprehensive neuropsychological battery was used to examine depression, self-assessment of functioning, and cognitive performance in six domains of functioning. Group differences were assessed by HIV-1 status and sex, controlling for age and education. Results indicated that cognitive deficits were substantially greater among male participants with HIV-1 clade C compared to male controls in all domains of cognitive functioning; in contrast, women with HIV-1 clade C had only minor deficits compared to healthy female participants. In addition, a larger proportion of men with HIV-1 clade C exhibited high levels of depression than women with HIV-1 clade C. These findings suggest that untreated HIV-1 clade C infection in men can have debilitating effects on neuropsychological function and depression, and stress the importance of facilitating rapid access to treatment to reduce the impact of HIV-1 infection.

Evaluation of smoking cessation interventions for veterans in HIV clinics in the United States: a theory-informed concurrent mixed-method study

Objective

Although veterans living with HIV infection are burdened with smoking-related morbidities, few studies have explored theory-informed, evidence-based smoking cessation interventions in the Veterans Affairs (VA) Health System.

Method

In this concurrent mixed-method study, we sought to better understand factors influencing the adoption of existing evidence-based smoking cessation interventions (reminders, telephone quit lines, pharmacological) for veterans in VA HIV clinics. We explored the alignment of the revised Promoting Action on Research Implementation in Health Services Framework (i-PARIHS) with study results.

Results

Nineteen clinicians working at eight HIV clinics in the VA System participated in the study. Seven themes were identified with relative quantitative and qualitative data convergence of clinicians’ perceptions of the importance of integrating evidence-based smoking cessation interventions for veterans with HIV infection.

Conclusion

Identified themes underscore the need for clinicians to provide smoking cessation training, supportive care, and motivate veterans living with HIV infection to quit smoking. Integrating smoking cessation programs into HIV treatment plans in the veteran patient population is critical. Dedicated time to fully implement these efforts will maximize smoking cessation intervention efforts and will yield successful utilization and subsequent patient compliance. Importantly, combination strategies will ensure cessation program impact and sustainability.

Trial registration:Netherlands National Trial Register identifier: ntr050..

Tobacco Use and Health-Related Quality of Life Among Individuals with Depression Who Are Receiving Treatment for HIV in Cape Town, South Africa

BACKGROUND

Tobacco use is the leading cause of preventable death worldwide, and prevalence rates are high among people living with HIV (PLWH), particularly in men. Depression is also common among PLWH, especially among smokers, who may use tobacco to manage mood. Although HIV and depression have been linked to functional impairment and poor health-related quality of life (HRQOL), little research has examined the degree to which smoking impacts these relationships in low- and middle-income countries with high HIV burden.

METHOD

Participants (N = 289) were people living with HIV (PLWH) who were being assessed for inclusion in a study targeting depression as a barrier to HIV medication adherence. Linear regression models measured the effect of gender on tobacco use (assessed by the WHO-ASSIST) and on each of the five HRQOL functional impairment domains (assessed by the SF-21). Separate multivariable regression models examined the relationships between habitual tobacco use, defined as daily, almost daily, or weekly use, and the HRQOL domains.

RESULTS

The prevalence of habitual tobacco use was 23.9% (48.1% among men, 15.5% among women). Habitual tobacco use was associated with decreased cognitive functioning for the whole sample (B = - 8.99, p < 0.05) and with lower levels of pain-related impairment for men (B = 18.1, p < 0.05). Although men reported more tobacco use (B = 8.50, p < 0.001), they reported less pain-related limitations than women (B = 8.70, p < 0.05).

CONCLUSIONS

In our sample, men reported higher rates of habitual tobacco use than women. Smoking was associated with cognitive impairment and with less pain-related impairment among men. Future smoking cessation treatments tailored to PLWH who have symptoms of depression may benefit from strategies that consider pain management as a pathway to habitual smoking and recognize that motivations for use may differ by gender.

Relationships among Self-Efficacy, Quality of Life, Perceived Vulnerability, and Readiness to Quit Smoking in People Living with HIV

Smoking-related diseases (e.g., lung cancer) are the leading cause of mortality in HIV-infected patients. While many PLWH who smoke report a desire to quit, a majority of them have low readiness to quit. This study used logistic and linear regression to examine the relations among two (continuous vs. binary) measures of readiness to quit, smoking cessation self-efficacy (SE), quality of life (QoL), and perceived vulnerability (PV) using baseline data from 100 PLWH who smoke who participated in a clinical trial. Results showed no significant main effects (SE, QoL, and PV) or interaction effects (SE × QoL and SE × PV) on a continuous measure of readiness to quit. However, a follow-up analysis revealed that SE had a curvilinear effect on readiness to quit such that self-efficacy was positively associated with readiness to quit except at the highest levels of self-efficacy where readiness to quit declined. Greater SE significantly increased the likelihood of reporting readiness to quit (yes/no) among those with low QoL or high PV. For PLWH who smoke, improving self-efficacy may increase readiness to quit especially among those with lower quality of life. Psychoeducation tailored to PLWH designed to reduce unrealistic invulnerability to smoking-related diseases along with interventions that target self-efficacy may improve readiness to quit.

Pain self-efficacy, race, and motivation to quit smoking among persons living with HIV (PLWH)

Pain and cigarette smoking are commonly co-occurring and costly public health issues, and rates of both conditions are elevated among persons living with HIV (PLWH). Recent work has focused on elucidating the role of cognitive factors in pain-smoking interrelations, and PLWH have endorsed various beliefs regarding pain and smoking. There is reason to suspect that pain self-efficacy (i.e., belief in one's ability to cope with pain) may be associated with the maintenance of smoking. However, no previous research has examined relations between pain self-efficacy and motivation to quit. The goal of this study was to conduct the first test of cross-sectional associations between pain self-efficacy and motivation to quit smoking among PLWH. Race was tested as a moderator of the hypothesized associations. Participants (N = 76 daily smokers; 37% female; M_age = 50.6; M_CPD = 13.7) were recruited from an outpatient infectious disease clinic for a primary study examining the effects of a personalized feedback intervention for PLWH. Results indicated that pain self-efficacy was positively associated with perceived importance of quitting and intention to quit within the next six months across the entire sample (ps < 0.05), and positively associated with readiness to consider smoking cessation and confidence in quitting among Black/African American participants (but not among other participants; ps < 0.05). These data provide initial evidence that pain self-efficacy may be related to motivation and intention to quit smoking, particularly among Black/African American PLWH. Future research should test prospective associations between pain self-efficacy and the initiation/maintenance of smoking cessation.

Comprehensive Assessment of Alcohol Consumption in People Living with HIV (PLWH): The New Orleans Alcohol Use in HIV Study

BACKGROUND

High frequency of alcohol use among people living with HIV (PLWH) warrants careful assessment and screening to better understand its impact on HIV disease progression and development of comorbidities. Due to the limitations of the tools used to measure alcohol use, the links to health consequences are not fully understood.

METHODS

We completed a cross-sectional analysis to examine the prevalence of alcohol consumption using multiple alcohol assessment tools and their correlation and consistency in a cohort of PLWH (N = 365) enrolled in the New Orleans Alcohol Use in HIV (NOAH) Study. Alcohol use was assessed with the Alcohol Use Disorders Identification Test (AUDIT), timeline followback (TLFB) Calendar, lifetime drinking history, Alcohol and Drug Addiction Severity Index, and blood levels of phosphatidylethanol (PEth). Spearman's correlations were estimated for continuous measures of alcohol consumption; Wilcoxon rank-sum tests were used to compare means; and logistic regression was used to estimate odds of alcohol use by demographic characteristics.

RESULTS

Self-report of current alcohol use varied from 58.9 to 73.7% depending on the assessment. All the self-reported alcohol measures showed statistically significant correlations with the biological marker PEth. The highest correlation was with TLFB grams (r = 0.67, p < 0.001). Using TLFB, 73.7% of the cohort reported using alcohol in the last 30 days, and 61.6% had a positive PEth value. The prevalence of risky drinkers, meeting the TLFB > 3 (women) or >4 (men) drinks/day or>7 (women) or>14 (men) drinks/week, was 49.0%. Medium-risk drinking defined as an AUDIT score ≥ 8 was reported in 40.3%, and high-risk drinkers/probable AUD (AUDIT score ≥ 16) was met by 17.0% of the cohort.

CONCLUSIONS

Our results demonstrate the importance of comprehensive assessments for alcohol use, including self-report via multiple assessment tools administered by trained staff, as well as the addition of biomarkers for improved classification of subjects into different drinking categories.

Extracellular Vesicles in Smoking-Mediated HIV Pathogenesis and their Potential Role in Biomarker Discovery and Therapeutic Interventions

In the last two decades, the mortality rate in people living with HIV/AIDS (PLWHA) has decreased significantly, resulting in an almost normal longevity in this population. However, a large portion of this population still endures a poor quality of life, mostly due to an increased inclination for substance abuse, including tobacco smoking. The prevalence of smoking in PLWHA is consistently higher than in HIV negative persons. A predisposition to cigarette smoking in the setting of HIV potentially leads to exacerbated HIV replication and a higher risk for developing neurocognitive and other CNS disorders. Oxidative stress and inflammation have been identified as mechanistic pathways in smoking-mediated HIV pathogenesis and HIV-associated neuropathogenesis. Extracellular vesicles (EVs), packaged with oxidative stress and inflammatory agents, show promise in understanding the underlying mechanisms of smoking-induced HIV pathogenesis via cell-cell interactions. This review focuses on recent advances in the field of EVs with an emphasis on smoking-mediated HIV pathogenesis and HIV-associated neuropathogenesis. This review also provides an overview of the potential applications of EVs in developing novel therapeutic carriers for the treatment of HIV-infected individuals who smoke, and in the discovery of novel biomarkers that are associated with HIV-smoking interactions in the CNS.

Sexual Orientation Differences in Modifiable Risk Factors for Cardiovascular Disease and Cardiovascular Disease Diagnoses in Men

PURPOSE

Despite higher rates of modifiable risk factors for cardiovascular disease (CVD) in gay and bisexual men, few studies have examined sexual orientation differences in CVD among men. The purpose of this study was to examine sexual orientation differences in modifiable risk factors for CVD and CVD diagnoses in men.

METHODS

A secondary analysis of the National Health and Nutrition Examination Survey (2001-2012) was conducted. Multiple imputation was performed for missing values. Differences across four distinct groups were analyzed: gay-identified men, bisexual-identified men, heterosexual-identified men who have sex with men (MSM), and heterosexual-identified men who denied same-sex behavior (categorized as exclusively heterosexual). Multiple logistic regression models were run with exclusively heterosexual men as the reference group.

RESULTS

The analytic sample consisted of 7731 men. No differences between heterosexual-identified MSM and exclusively heterosexual men were observed. Few differences in health behaviors were noted, except that, compared to exclusively heterosexual men, gay-identified men reported lower binge drinking (adjusted odds ratio [AOR] 0.58, 95% confidence interval [CI] = 0.37-0.85). Bisexual-identified men had higher rates of mental distress (AOR 2.39, 95% CI = 1.46-3.90), obesity (AOR 1.69, 95% CI = 1.02-2.72), elevated blood pressure (AOR 2.30, 95% CI = 1.43-3.70), and glycosylated hemoglobin (AOR 3.01, 95% CI = 1.38-6.59) relative to exclusively heterosexual men.

CONCLUSIONS

Gay-identified and heterosexual-identified MSM demonstrated similar CVD risk to exclusively heterosexual men, whereas bisexual-identified men had elevations in several risk factors. Future directions for sexual minority health research in this area and the need for CVD and mental health screenings, particularly in bisexual-identified men, are highlighted.

Non-infectious Pulmonary Diseases and HIV

Pulmonary complications remain among the most frequent causes of morbidity and mortality for individuals with HIV despite the advent of antiretroviral therapy (ART) and improvement in its efficacy and availability. The prevalence of non-infectious pulmonary diseases is rising in this population, reflecting both an increase in smoking and the independent risk associated with HIV. The unique mechanisms of pulmonary disease in these patients remain poorly understood, and direct effects of HIV, genetic predisposition, inflammatory pathways, and co-infections have all been implicated. Lung cancer, chronic obstructive pulmonary disease (COPD), and pulmonary hypertension are the most prevalent non-infectious pulmonary diseases in persons with HIV, and the risk of each of these diseases is higher among HIV-infected (HIV+) persons than in the general population. This review discusses the latest advances in the literature on these important complications of HIV infection.

Veterans Living with HIV: A High-Risk Group for Cigarette Smoking

The Veterans Health Administration is the largest U.S. medical provider for persons living with HIV (PLHIV). Although HIV and veteran status are known risk factors for smoking, there are no population estimates of smoking prevalence among veteran PLHIV. Using data from a national random sample (National Survey on Drug Use and Health; 2005-2014), smoking prevalence was estimated by self-reported veteran and HIV status (N = 376,620). Results indicated 42% of veteran PLHIV smoked daily, compared to 18% of veterans without HIV and 30% of non-veteran PLHIV. Findings suggest that veteran PLHIV have high risk for smoking and consequent poor health.

Pilot evaluation of a brief intervention to improve nicotine patch adherence among smokers living with HIV/AIDS

Nicotine replacement therapy is an effective intervention for smoking cessation, but adherence tends to be low. This article presents results from a pilot evaluation of a brief smoking cessation treatment to improve adherence to the nicotine patch among Latino smokers living with HIV/AIDS. Forty smokers were randomized to receive either a standard 5 As counseling session and 8-week treatment of nicotine patch, or a similar intervention that added a 10-min module to the 5 As counseling that focused on improving adherence to the nicotine patch. Smoking outcomes (breath carbon monoxide monitoring verified 7-day point prevalence and continuous abstinence) were evaluated through a 3-month follow-up. Patch usage during the follow-up period was also assessed. Intention to treat analyses indicated that abstinence rates were 2 to 3 times higher in the adherence condition compared with the standard condition (7-day point prevalence abstinence: 35.0% vs. 15.0%; continuous abstinence: 30.0% vs. 10.0%). Nicotine patch compliance over an 8-week period was also higher in the adherence condition than in the standard condition (44% vs. 25%). Although this small pilot was conducted to estimate effect sizes and was not powered to detect group differences, results are promising and suggest that adding a 10-min module focused on nicotine patch adherence to a standard 5 As protocol can increase abstinence rates. Given that this smoking cessation treatment was not specifically tailored to either HIV-positive smokers or Latino smokers, future research should examine whether it may be a promising approach for improving nicotine patch adherence in the general population of smokers. (PsycINFO Database Record