The relationship of smoking and unhealthy alcohol use to HIV care retention and viral suppression: findings from a multi-site cohort study
Within the Antiretroviral Therapy Cohort Collaboration (ART-CC), Satre et al. evaluated the influence of smoking and unhealthy alcohol use on HIV care. They used data from more than 80,000 participants from the SHCS and 10 other cohorts from North America and Western Europe who had at least one assessment of smoking status and alcohol use between 2010 and 2018. The outcomes were viral non-suppression, defined as a HIV viral load ≥200 copies/ml, and loss to care, defined as fewer than two HIV care visits within 12 months.
People with HIV who were current smokers had a higher risk of loss to care than their non-smoking counterparts (pooled prevalence ratio [PPR] 1.12, 95% confidence interval [CI] 1.08–1.16, I²=18.1%) and a higher risk of viral non-suppression (PPR 1.44, 95% CI 1.25–1.67, I²=90.6%). Similarly, people with HIV reporting heavy drinking had a higher risk of loss to care (PPR 1.13, 95% CI 1.03–1.25, I²=57.8%) and viral non-suppression (PPR 1.18, 95% CI 1.02–1.37, I²=68.9%) than those reporting low/moderate drinking. No significant differences were observed among non-drinking people with HIV compared with those reporting low/moderate drinking. In an analysis combining smoking and alcohol consumption, people with HIV who reported both current smoking and heavy drinking had a 74% higher risk of viral non-suppression and a 25% higher risk of loss to care compared with non-smoking people with HIV reporting low/moderate alcohol use.
In conclusion, both smoking and unhealthy alcohol use were associated with lower retention in HIV care and lower rates of viral suppression. Self-reported smoking and alcohol consumption may serve as useful risk indicators and could help identify individuals who may benefit from targeted support to improve continuity of HIV care.