Gender, socioeconomic factors, and race/ethnicity linked to comorbidities among smokers with HIV

Reviewed by Danielle Ellis, B.Sc.Jul 14 2023

High rates of smoking among people with HIV are associated with high rates of comorbid health problems – which are associated with characteristics including gender, race/ethnicity, and socioeconomic status, according to a study in the July issue of The Journal of the Association of Nurses in AIDS Care (JANAC). The official journal of the Association of Nurses in AIDS Care, JANAC is published in the Lippincott portfolio by Wolters Kluwer.

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."

Jessica L. Elf, PhD, lead author, Colorado State University, Fort Collins

Nearly half of smokers with HIV have mental health comorbidity

To clarify the types of comorbidities among people with HIV who smoke have, as well as the characteristics associated with that group, the researchers analyzed data from an ongoing follow-up study of people with HIV living in the Washington, DC area (the DC Cohort Longitudinal HIV Study). Of nearly 8,600 participants enrolled in the study, 50% were smokers.

In the DC Cohort, people with HIV who smoked were predominantly young (57% younger than 50 years), male (71%), and non-Hispanic Black (85%). About three-fourths were unemployed, and only 15% had private health insurance. The study focused on comorbidity from mental health problems and from cardiovascular disease, pulmonary disease, or cancer (CPC comorbidity).

Overall, more than half (54%) of smokers with HIV had some type of comorbid health condition. This included a mental health disorder in 49% of participants. Rates of CPC comorbidity were four percent for cardiovascular disease, eight percent for cancer, and two percent for pulmonary disease.

Comorbidity was to a wide range of demographic and socioeconomic factors among people with HIV who smoked. Those with mental health comorbidity were more likely to be older, white, and female; to be on public health insurance or uninsured; and to have unstable housing conditions.

Tailored quit-smoking programs should target comorbidity risks in people with HIV

Risk of CPC comorbidity was strongly associated with older age, female sex, and non-Hispanic Black race/ethnicity. Comorbid CPC was also linked to unstable housing, but not to other sociodemographic factors.

Comorbidity was also increased for participants with poorer clinical characteristics: AIDS diagnosis, lower CD4+ cell count, and high viral load. These associations were stronger for CPC than for mental health comorbidity. Substance use did not appear to affect comorbidity risks.

The findings are consistent with previous studies showing high rates of smoking among people with HIV. As life expectancy has increased dramatically for people with HIV, they experience a high additional burden of smoking-related and other comorbidities – which may contribute to low rates of successful quitting. "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, tailored smoking cessation programs have been found more effective in specific subgroups, including those with CPC diagnoses. However, few quit-smoking interventions specific for marginalized or high-risk subgroups have been developed or tested for people with HIV.

"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."