Abstract
BackgroundAlthough the various groups of people living with HIV (PLWHIV) considerably differ regarding socioeconomic and behavioral characteristics, their specificities regarding tobacco smoking have been poorly investigated. We aimed to assess patterns of tobacco consumption across the various groups of PLWHIV and to compare them to the general population, accounting for the specific socioeconomic profile of PLWHIV.MethodsWe used data of the ANRS-Vespa2 study, a national representative survey on PLWHIV conducted in France in 2011. Prevalence of past and current tobacco consumption, heavy smoking and strong nicotine dependence were assessed among the various groups of PLWHIV as defined by transmission category, gender and geographic origin, and compared to the French general population using direct standardization and multivariate Poisson regression models, accounting for gender, age, education and geographic origin.ResultsAmong the 3,019 participants aged 18–85 years (median time since HIV diagnosis: 12 years), 37.5% were current smokers and 22.1% were past smokers, with marked differences across the various groups of PLWHIV. Compared to the general population, the prevalence of regular smoking was increased among HIV-infected men who have sex with men (MSM) (adjusted prevalence rate ratio (aPRR): 1.19, 95% confidence interval (95% CI): 1.07–1.32), French-native women (aPRR: 1.32, 95% CI: 1.10–1.57), and heterosexual French-native men (although not significantly, aPRR: 1.19, 95% CI: 0.98–1.45). Additionally, HIV-infected MSM were significantly less likely to be ex-smokers (aPRR: 0.73, 95% CI: 0.64–0.82) than the general population and similar trends were observed among heterosexual French-native men (aPRR: 0.89, 95% CI: 0.78–1.02) and women (aPRR: 0.84, 95% CI: 0.70–1.01). HIV-infected sub-Saharan African migrants were less likely to be regular smokers than the general population.ConclusionsSmoking constitutes a major concern in various groups of PLWHIV in France including MSM and heterosexual French-natives, probably resulting from PLWHIV being less likely to quit smoking than their counterparts in the general population.
Highlights
With the sustained use of combined antiretroviral therapies, HIV-associated morbidity and mortality have dramatically fallen and the life expectancy of people living with HIV (PLWHIV) has considerably increased over the past two decades [1,2]
13.4% were IDU, 36.7% were men who have sex with men (MSM), 22.4% were heterosexual French-natives, 23.7% were heterosexual migrants from sub-Saharan Africa (SSA) and 3.8% were heterosexual migrants originating from other regions mainly North Africa (1.2%) and Europe (1.0%)
These various groups showed marked differences in terms of age and educational attainment (with a proportion of individuals with more than a high school diploma ranging from 11.1% among heterosexual SSA migrant women to 44.1% among MSM (Table 1)
Summary
With the sustained use of combined antiretroviral therapies (cART), HIV-associated morbidity and mortality have dramatically fallen and the life expectancy of people living with HIV (PLWHIV) has considerably increased over the past two decades [1,2]. The burden of non-AIDS related conditions (including cardiovascular diseases and cancers) on PLWHIV’s health has considerably increased [3,4,5]. Various concurrent pathways have been suggested to explain this increased burden of non-AIDS related conditions among PLWHIV, including the consequences of cART, HIV infection and/or chronic inflammation, as well as a high level of exposure to cardiovascular risk factors [7,8,9]. Non-AIDS related co-morbidities have major consequences on PLWHIV’s mortality, quality of life [10] and social functioning [11]. They need to be carefully monitored and prevented by the management of modifiable behavioral risk factors. We aimed to assess patterns of tobacco consumption across the various groups of PLWHIV and to compare them to the general population, accounting for the specific socioeconomic profile of PLWHIV
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