TRENDS IN CIGARETTE SMOKING AND THE RELATIONSHIP WITH FAILING TO BE RETAINED IN HIV PRIMARY CARE, 2008-2010
Embargo until
2015-05-01
Date
2014-04-28
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Johns Hopkins University
Abstract
Introduction: Currently, there are over a million individuals living with HIV in North America, with over one-third not in HIV primary care and twice as many reporting cigarette smoking as non-HIV-infected individuals. Few smoking cessation programs exist to target this population and little research has been focused on the relationship between smoking and retention in care. The objectives were to describe patterns of smoking in HIV-infected adults by demographic characteristics and to estimate the association of smoking on failing to be retained in HIV primary care.
Methods: Analysis included data from five clinical cohorts from the North American Cohort Collaboration on Research and Design (NA-ACCORD). Adults retained in care during the year of their first visit and who contributed laboratory and smoking data for at least two visits from 2008 to 2010 were analyzed. Smoking status was time-varying and defined as never, ever, or current. Retention in care was defined as ≥2 HIV primary care visits ≥90 days apart in a calendar year. Trends in smoking statuses were described by clinical and demographic characteristics such as age, sex, race, injection drug use (IDU) as HIV risk factor, region of residence, and highly active antiretroviral therapy (HAART) use. Trends in the proportions of never/ever/current smokers were detected using logistic regression models with generalized estimating equations (GEE) using independent correlation matrixes and robust variance estimations. Univariate and multivariate Cox proportional hazard models with the Efron method for ties were used to assess associations between time-varying smoking status and failing to be retained in HIV primary care over the study period.
Results: The sample of 3,575 HIV+ participants were 74% male, 47% African American, 19% IDUs, and 62% Southern US residents. At baseline, 28% were current smokers, 43% ever smokers, and 28% never smokers. 17% of the NA-ACCORD population failed to be retained in care from 2008 to 2010, with a reduced risk among ever smokers (vs. never) and an increased risk among current smokers (vs. never).
Conclusions: Programs incorporating smoking cessation into HIV clinical care may help better retain current smokers who are trying to quit.
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Keywords
HIV retention, smoking