Comorbidity is Linked to Gender, Ace, and Socioeconomic Level among Smokers with HIV

According to a study published in the July issue of The Journal of the Association of Nurses in AIDS Care, high rates of smoking among people with HIV are connected to high rates of comorbid health issues, which are connected to traits like gender, race/ethnicity, and socioeconomic status.

According to senior author Jessica L. Elf, Ph.D., of Colorado State University, Fort Collins, “People with HIV who smoke are at high risk of accompanying physical and mental health conditions. Understanding the characteristics of people with HIV who smoke and have comorbidities may inform the development of smoking cessation interventions for groups who are likely to have a difficult time quitting smoking.”

Mental health comorbidity affects nearly half of smokers with HIV.
The researchers examined data from a running follow-up study of persons with HIV residing in the Washington, DC region known as the DC Cohort Longitudinal HIV Study to better understand the sorts of comorbidities that people with HIV who smoke have as well as the features linked to that group. In the study, there were around 8,600 participants, and 50% of them smoked.

People with HIV who smoked in the DC Cohort were mostly male (71%), non-Hispanic Black (85%), and young (57% under 50 years old). Only 15% of people had private health insurance, and around three-fourths were unemployed. The study concentrated on comorbidity (CPC comorbidity) between mental health issues and cardiovascular illness, lung disease, or cancer.

In all, smokers with HIV who also smoked had a comorbid health condition in 54% of cases. In 49% of the participants, a mental health issue was present. The prevalence of CPC comorbidity was 4% for cardiovascular disease, 8% for cancer, and 2% for pulmonary disease.

People with HIV who smoked had comorbidities with a variety of demographic and socioeconomic characteristics. It was more common for people with mental health comorbidity to be older, Caucasian, female, on public health insurance or without insurance, and to live in unstable housing.

Programmes to help smokers quit should focus on comorbidity concerns in HIV-positive individuals

Strong correlations were found between older age, female sex, and non-Hispanic Black race/ethnicity with the risk of CPC comorbidity. Instable housing was also associated with comorbid CPC, but not other sociodemographic elements.

Participants with worse clinical characteristics—AIDS diagnosis, lower CD4+ cell count, and high viral load—also had higher rates of comorbidity. The correlations between CPC and mental health comorbidity were stronger. The risk of comorbidity did not appear to be affected by substance use.

The results are in line with other research indicating a high proportion of smoking among HIV-positive individuals. Due to the huge rise in HIV-related comorbidities among adults with longer life expectancies, there may be fewer effective attempts to quit smoking among this population.

“People with HIV who have other co-morbidities may have a more difficult time quitting smoking because of their comorbidity,” Dr. Elf explains. “They may also fall into sociodemographic groups that traditionally have a more difficult time quitting smoking.”

In the general population, some subgroups, especially those with CPC diagnoses, have been proven to benefit more from specialised smoking cessation programmes. However, very few quit-smoking programmes tailored to at-risk or marginalised populations have been created or tested for HIV-positive individuals.

“We need to prioritize the development of effective smoking cessation strategies for people with HIV who smoke and have concurrent smoking-related mental and physical health problems,” Dr. Elf adds. “Our findings highlight the need for special attention to higher-risk characteristics such as lower socioeconomic status, female gender, and minority race/ethnicity.”