The relationship of smoking and unhealthy alcohol use to HIV care retention and viral suppression: findings from a multisite cohort study

Abstract

Objectives: Tobacco smoking and alcohol use may negatively influence HIV care, but associations have not been examined across cohorts.

Design: Multisite international collaboration of cohort studies.

Methods: People with HIV (PWH) were included from 11 cohorts; 5 North American and 6 Western European. Exposures were harmonized smoking and alcohol measures (2010-2018). Loss to care was defined as not having 2+ HIV care visits (HIV RNA and/or CD4 measurement dates) at least 60 days apart, within 12 months following alcohol measure date; HIV viral nonsuppression was defined as >200 copies/ml. Adjusted prevalence ratios (PRs) were estimated using modified Poisson regression; pooled effect estimates and the heterogeneity measure ( I2 ).were derived from a random-effect meta-analysis.

Results: Among 83 102 PWH (87.4% male, 46.1% white); 43.7% currently smoked, 44.5% reported low/moderate drinking, 6.9% heavy drinking, 48.6% did not drink. PWH who currently smoked had higher risk of loss to care than nonsmoking PWH (pooled PR [95% CI] = 1.12 [1.08-1.16], I2 = 18.1%); those with heavy drinking had higher risk than those with low/moderate drinking (1.13 [1.03-1.25], I2 = 57.8%). PWH who currently smoked had higher risk of viral nonsuppression than nonsmoking PWH (1.44 [1.25-1.67], I2 = 90.6%); those reporting heavy drinking had higher risk than those with low/moderate drinking (pooled PR [95% CI] = 1.18 [1.02-1.37], I2 = 68.9%). PWH who reported heavy drinking and current smoking, in comparison to low/moderate alcohol use but no current smoking, had highest risk of viral nonsuppression (pooled PR [95% CI] =1.74 [1.37-2.22]), I2 = 81.8%.

Conclusions: Smoking and unhealthy alcohol use were associated with HIV loss to care and viral nonsuppression, with variability between cohorts.

Keywords: HIV care; alcohol; primary care; smoking; tobacco; viral suppression.