Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, CA, USA; Kaiser Permanente Northern California, Oakland, CA, USA.
Kaiser Permanente Northern California, Oakland, CA, USA.
Drug Alcohol Depend. 2021 Feb 1;219:108481. doi: 10.1016/j.drugalcdep.2020.108481. Epub 2021 Jan 8.
Smoking tobacco and unhealthy alcohol use may negatively influence HIV care continuum outcomes but have not been examined in combination.
Participants were people with HIV (PWH) in Kaiser Permanente Northern California. Predictors included smoking status and unhealthy alcohol use (exceeding daily and/or weekly limits) reported by patients during primary care screening (index date). Outcomes were based on not achieving the following steps in the care continuum: linkage to HIV care (≥1 visit within 90 days of newly identified HIV diagnosis), retention (2+ in-person visits, 60+ days apart) and HIV RNA control (<75 copies/mL). Adjusted odds ratios (ORs) were obtained from separate logistic regression models for each outcome associated with smoking and unhealthy alcohol use independently and combined.
The overall sample (N = 8958) had a mean age of 48.0 years; was 91.3 % male; 54.0 % white, 17.6 % Latino, 15.1 % black, and 9.6 % other race/ethnicity. Smoking was associated with higher odds of not being linked to HIV care (OR = 1.60 [95 % CI 1.03-2.48]), not retained (OR = 1.30 [95 % CI 1.13-1.50]), and HIV RNA not in control (OR = 1.91 [95 % CI 1.60-2.27]). Alcohol measures were not independently associated with outcomes. The combination of unhealthy alcohol use and smoking (versus neither) was associated with higher odds of not being linked to care (OR = 2.83 [95 % CI 1.40-5.71]), although the interaction did not reach significance (p = 0.18).
In this large sample of PWH in an integrated health care system, smoking, both independently and in combination with unhealthy alcohol use, was associated with worse HIV care continuum outcomes.
吸烟和不健康的饮酒可能会对 HIV 护理连续体的结果产生负面影响，但尚未同时进行研究。
参与者为 Kaiser Permanente 北加利福尼亚州的 HIV 感染者（PWH）。预测因素包括患者在初级保健筛查期间（索引日期）报告的吸烟状况和不健康的饮酒（每日和/或每周超过限制）。结果基于未达到以下 HIV 护理连续体的步骤：与 HIV 护理的联系（新诊断 HIV 后 90 天内≥1 次就诊）、保留（2 次以上面对面就诊，相隔 60 天以上）和 HIV RNA 控制（<75 拷贝/ml）。使用独立的逻辑回归模型获得与吸烟和不健康饮酒相关的每个结果的调整优势比（OR），并分别对吸烟和不健康饮酒进行调整。
总体样本（N=8958）的平均年龄为 48.0 岁；91.3%为男性；54.0%为白人，17.6%为拉丁裔，15.1%为黑人，9.6%为其他种族/民族。吸烟与未与 HIV 护理联系的可能性更高相关（OR=1.60[95%CI 1.03-2.48]），未保留（OR=1.30[95%CI 1.13-1.50]），以及 HIV RNA 未得到控制（OR=1.91[95%CI 1.60-2.27]）。酒精测量指标与结果没有独立关系。与既不吸烟也不饮酒（与既不吸烟也不饮酒相比）相比，不健康的饮酒和吸烟的组合与未与护理联系的可能性更高相关（OR=2.83[95%CI 1.40-5.71]），尽管这种相互作用没有达到显著性（p=0.18）。
在这个大型综合医疗保健系统的 HIV 感染者样本中，吸烟（独立和与不健康饮酒相结合）与 HIV 护理连续体的结果更差相关。
