Comorbidities in HIV Patients Who Smoke Linked to Gender, Socioeconomic Status


Comorbidities assessed included cardiovascular, cancer, pulmonary, and mental health diagnoses, chosen due to their relation to smoking and their substantial mortality burden.

A new study featured in the Journal of the Association of Nurses in AIDS Care found that among people with HIV (PWH) who smoke, comorbidities were associated with gender, race, and socioeconomic status.

Among PWH, smoking prevalence is higher than 40%, which is at least twice as high compared with the general population. PWH are also less likely to quit smoking, the study authors noted. Smoking cessation interventions are focused on people who have smoking-related comorbidities, as they are a high-priority population. This should include PWH, according to the authors, as it may help increase quitting success.

The study aimed to illluminate the socioeconomic, demographic, and clinical correlates of smoking-related physical and/or mental health comorbidities among PWH who smoke.

The cross-sectional analysis used the D.C. Cohort Longitudinal HIV study, which recruits participants from 15 HIV care centers in the Washington, D.C. metropolitan area. Data from January 2011 to March 2017 were used for this study. Clinical and sociodemographic data were collected electronically or manually at the time of enrollment from medical records. All participants were classified as current, former, never, or unknown smokers.

Comorbidities included cardiovascular, cancer, pulmonary (CPC), and mental health diagnoses, chosen due to their relation to smoking and their substantial mortality burden. Participants were classified by number of comorbidities, ranging from 0 to 4.

There were 8665 participants in the study, of which 99% were adults; of the 50% of participants who were smokers, 57% were younger than 50 years, 85% were non-Hispanic Black, and 71% were male.

The researchers found that those aged 50-59 years had a 20% increased risk of a mental health comorbidity (prevalence ratio [PR], 1.19; 95% CI, 1.09-1.31). Age was found to be associated with a CPC comorbidity, with those aged 50-59 years having an effect size of 1.97 (95% CI, 1.46-2.65), those aged 40-49 years having an effect size of 1.52 (95% CI, 1.12-2.05), and those older than 60 years having an effect size of 4.11 (95% CI, 3.00-5.63).

A lower risk for a mental health comorbidity was found in non-Hispanic Black participants (PR, 0.69; 95% CI, 0.62-0.76) compared with non-Hispanic White participants. Participants who identified as male had a lower risk of mental health and CPC comorbidities compared with female participants, with the CPC comorbidity (PR, 0.68; 95% CI, 0.57-0.81) having the stronger effect size compared with mental health (PR, 0.88; 95% CI, 0.81-0.94).

The risk for a mental health comorbidity was higher in participants who had public or no health insurance (PR, 1.43; 95% CI, 1.25-1.64); who were disabled, a student, or retired (PR, 1.27; 95% CI, 1.05-1.54); and who did not have any permanent residence (PR, 1.17; 95% CI, 1.08-1.26). Those without a permanent residence also had a higher risk of a CPC comorbidity (PR, 1.65; 95% CI, 1.33-2.05). Participants who did not live in Washington, D.C. had a lower risk of mental health comorbidities (PR, 0.91; 95% CI, 0.82-1.00) but instead had a higher risk of a CPC comorbidity (PR, 1.26; 95% CI, 1.03-1.55).

Some limitations of this study included that there was no biochemical validation to confirm smoking status. Other types of tobacco were not accounted for. Broad categories were used to group selected comorbidities, which could have led to people with multiple comorbidities in 1 category to be classified as having 1 comorbidity. The definitions of the comorbidities could have led to the lower prevalence of comorbidities observed in the data set. The results may not be generalizable to other parts of the United States.

"Understanding the characteristics of PWH who smoke and have comorbidities, and developing cessation strategies through this lens, is needed to continue to identify the most effective and efficient way to support PWH quit smoking, especially those with a comorbidity, and may be a way to help reduce this persistent health disparity," the authors concluded.


Elf JL, Horn K, Abroms L, et al. Prevalence and correlates of cardiovascular, pulmonary, cancer, and mental health comorbidities among adults with HIV who smoke. J Assoc Nurses AIDS Care. 2023;34(4):363-375. doi:10.1097/JNC.0000000000000416

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