Abstract
BackgroundPeople living with HIV (PLWH) who drink alcohol and use tobacco are particularly vulnerable to tobacco-induced diseases due to an already compromised immune system. This study investigated the prevalence and factors associated with tobacco use (cigarette and snuff) among PLWH who drink heavily.MethodsParticipants (n = 623) on antiretroviral therapy for HIV who reported heavy drinking using the Alcohol Use Disorders Identification Test (AUDIT) and AUDIT-C were recruited from six hospitals in Gauteng Province, South Africa. The Fagerström test was used to assess nicotine dependence. Chi Square tests and modified Poisson regression analyses were conducted to identify factors associated with tobacco use.ResultsAlmost half of the participants reported ever smoking (44.0%; CI: 40.1–47.9) and about a quarter reported ever using snuff (25.5%; CI: 22.2–29.1). Current smokers and current snuff users comprised 27.3% (CI: 23.9–30.9) and 19.1% (CI: 16.2–22.3) of all participants respectively. Among current smokers, 37.9% (CI: 30.8–45.3) were moderately/highly dependent on nicotine. Current ‘any tobacco product users’ (ATPU: use cigarettes or snuff) were 45.4% (CI: 41.5–49.3) while 1.0% (CI: 0.4–2.0) currently used cigarettes and snuff. Adjusted regression analyses showed that, compared to males, females were less at risk of being: ever smokers (Relative Risk Ratio [RRR] = 0.33; CI: 0.27–0.41), current smokers (RRR = 0.18; CI: 0.12–0.25), and ATPU (RRR = 0.75; CI: 0.63–0.89) but were more at risk of ever snuff use (RRR = 5.23; CI: 3.31–8.25), or current snuff use (RRR = 26.19; CI: 8.32–82.40) than males. Ever snuff users (RRR = 1.32; CI: 1.03–1.70), current snuff users (RRR = 1.40; CI: 1.03–1.89) and ATPU (RRR = 1.27; CI: 1.07–1.51) were more at risk of reporting significant depressive symptoms. We found no significant associations between smoking status and years on ART and viral load.ConclusionThere is a high prevalence of cigarette and snuff use among PLWH who drink heavily. Tobacco use cessation interventions tailored specifically for this population and according to their tobacco product of choice are urgently needed given their vulnerability to ill-health.
Highlights
People living with Human immunodeficiency virus (HIV) (PLWH) who drink alcohol and use tobacco are vulnerable to tobacco-induced diseases due to an already compromised immune system
This paper reports on the crosssectional baseline data on tobacco use and nicotine dependence among people who participated in a randomized controlled trial testing the efficacy of an alcoholfocused intervention to reduce alcohol consumption and improve HIV treatment outcomes [20]
A study of smoking among 1210 People living with HIV (PLWH) conducted in Klerksdorp found a current smoking prevalence of about 25% based on self-report and 28% based on exhaled carbon monoxide and urine cotinine tests [5]
Summary
People living with HIV (PLWH) who drink alcohol and use tobacco are vulnerable to tobacco-induced diseases due to an already compromised immune system. PLWH have a higher tobacco use prevalence than the general population [5,6,7,8]. A case control study conducted in South Africa involving 279 men living with HIV and co-infected with tuberculosis (TB) reported a 33% smoking prevalence, a lower median CD4 count, and a higher median HIV viral load among smokers [10]. The odds of being diagnosed with TB were three times higher for current smokers and two times higher for former smokers compared to never smokers [10] Another South African study found the smoking prevalence among a sample of 1210 PLWH to be alarmingly high with 52% of men and 13% of women in the study confirmed as current smokers using urine cotinine and exhaled carbon monoxide tests [5]
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