Abstract
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 non-suppression was defined as >200 copies/mL. We calculated adjusted prevalence ratios (PRs) with modified Poisson regression, pooled effect estimates by random-effect meta-analysis, and variability (I2).
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 non-smoking 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 non-suppression than non-smoking 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 non-suppression (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 non-suppression, with variability between cohorts.
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 non-suppression was defined as >200 copies/mL. We calculated adjusted prevalence ratios (PRs) with modified Poisson regression, pooled effect estimates by random-effect meta-analysis, and variability (I2).
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 non-smoking 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 non-suppression than non-smoking 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 non-suppression (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 non-suppression, with variability between cohorts.
| Original language | English |
|---|---|
| Article number | 04329 |
| Journal | AIDS |
| Early online date | 4 Sept 2025 |
| DOIs | |
| Publication status | E-pub ahead of print - 4 Sept 2025 |
Bibliographical note
Publisher Copyright:© 2025 Wolters Kluwer Health, Inc.
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