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

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.