Document Type

Capstone Experience

Graduation Date

5-2020

Degree Name

Master of Public Health

Department

Epidemiology

First Committee Member

Theodore Cieslak

Second Committee Member

Gleb Haynatzki

Third Committee Member

Walter Scott Campbell

Fourth Committee Member

Abraham Mengist

Abstract

Background

Smoking is known to have a negative impact on both morbidity and mortality in people living with HIV (PLHIV). However, there is inconsistent information about the role of smoking on markers of HIV disease progression (CD4 count and HIV viral load). This study examined the effects of cigarette smoking on markers of HIV disease progression among PLHIV at Nebraska Medicine.

Methods

A retrospective cohort study was conducted utilizing electronic health information of 604 PLHIV who attended treatment at Nebraska Medicine between 2012 and 2020. Multiple linear regression was used to model the effects of smoking on the mean change in CD4 count between the first two visits while adjusting for other covariates. Also, multiple logistic regression was used to model the effects of smoking on viral load suppression status (having/ml at both visits or at the second visit versus having >=200 copies/ml at both visits or at the second visit).Other covariates were age at the first visit, sex, and race.

Results

The prevalence of current cigarette smoking was 40.7%. In the analysis of patients regardless of the Antiretroviral Therapy status(ART), older patients had less gain in CD4 count compared to younger patients (-1.16, 95%CI=-2.24,-0.067, p=0.03). However, older patients were more likely to be virally suppressed compared to younger patients (OR=1.02, 95% CI=1.003, 1.044, p=0.03). In the analysis of patients who were on ART, never-smokers had better gain in CD4 count compared to current smokers (OR=162.688, 95%CI=1.47, 243.88, p=0.0001). Also, females had less gain in CD4 count compared to males (-97.39, 95%=-188.29,-6.48, p=0.036).

Conclusion

The findings of lesser CD4 count recovery among current smokers compared to never-smokers indicate the need to implement Public health programs targeting smoking prevention and cessation among PLHIV.

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