Division of Infectious Diseases, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
J Acquir Immune Defic Syndr. 2022 Apr 1;89(4):428-432. doi: 10.1097/QAI.0000000000002880.
People with HIV (PWH) smoke tobacco at much higher rates than the general population. Previous research has shown that PWH have faster nicotine metabolism than HIV-uninfected individuals, which may underlie this disparity, but the cause is unknown. We investigated whether higher nicotine metabolite ratio (NMR; 3-hydroxycotinine:cotinine), a validated biomarker of nicotine metabolism through CYP2A6, was associated with antiretroviral use among HIV-infected smokers.
We conducted a retrospective cohort study of HIV-positive smokers in the University of Pennsylvania Center for AIDS Research cohort. We compared the NMR before viral suppression (>10,000 copies/mL) and after viral suppression on antiretroviral therapy (<200 copies/mL). We used mixed-effects linear regression to analyze the change in NMR after viral suppression and assessed for effect modification by efavirenz use.
Eighty-nine individuals were included in the study. We observed effect modification by efavirenz use (interaction term for efavirenz use, P < 0.001). Among those on nonefavirenz regimens, the mean NMR increased by 0.14 (95% confidence interval: 0.05 to 0.23, P = 0.002). Among those on efavirenz-containing regimens, the mean NMR increased by 0.53 (95% confidence interval: 0.39-0.66, P < 0.001).
We observed a clinically and statistically significant increase in NMR after viral suppression among smokers with HIV, which more than doubled among those on efavirenz-based regimens. Higher NMR among HIV-positive smokers on antiretroviral therapy may help explain the higher rates of tobacco use and lower quit rates among PWH in care. These findings suggest that regimen choice and other modifiable factors may be targets for future attempts to increase success rates for tobacco cessation among PWH.
HIV 感染者（PWH）吸烟的比例远高于普通人群。先前的研究表明，PWH 的尼古丁代谢速度比 HIV 未感染者快，这可能是造成这种差异的原因，但具体原因尚不清楚。我们研究了 HIV 感染者吸烟者中，通过 CYP2A6 验证的尼古丁代谢生物标志物——较高的尼古丁代谢比值（NMR；3-羟基可替宁/可替宁）是否与抗逆转录病毒药物的使用有关。
我们对宾夕法尼亚大学艾滋病研究中心队列中的 HIV 阳性吸烟者进行了回顾性队列研究。我们比较了病毒抑制（>10,000 拷贝/mL）前后以及抗逆转录病毒治疗后病毒抑制（<200 拷贝/mL）时的 NMR。我们使用混合效应线性回归来分析病毒抑制后 NMR 的变化，并评估依非韦伦使用的效应修饰作用。
研究共纳入 89 名患者。我们观察到依非韦伦使用的效应修饰作用（依非韦伦使用的交互项，P<0.001）。在未使用依非韦伦的方案中，NMR 平均增加 0.14（95%置信区间：0.05 至 0.23，P=0.002）。在使用含依非韦伦方案的患者中，NMR 平均增加 0.53（95%置信区间：0.39-0.66，P<0.001）。
我们观察到 HIV 感染者在病毒抑制后 NMR 有显著的临床和统计学上的增加，而在使用依非韦伦方案的患者中增加了一倍以上。接受抗逆转录病毒治疗的 HIV 阳性吸烟者中更高的 NMR 可能有助于解释 HIV 感染者在治疗中吸烟率较高和戒烟率较低的现象。这些发现表明，方案选择和其他可改变的因素可能是未来提高 HIV 感染者戒烟成功率的目标。
