Effect of Prevalent and Incident Comorbidity Diagnoses on Quit Attempts and Prescription of Smoking Cessation Medications, HIV Outpatient Study, 2007-2022.

backgroundPeople with HIV (PWH) are more likely to smoke, have comorbidities, and be less likely to quit than the general population. This study aimed to describe the prescription of smoking cessation medications and quit smoking attempts, and to assess the effect of prevalent and incident comorbidity diagnoses on these two outcomes.

methodsWe analyzed the 2007-2022 HIV Outpatient Study (HOPS) medical records and self-reported risk behavior survey data. We included adult PWH with evidence of current cigarette use at enrollment (baseline) or incident cigarette use. Comorbidities were identified based on laboratory results, clinical diagnoses, and treatments. We assessed associations of time-updated (baseline and incident) comorbidity diagnosis with prescription of smoking cessation medications and first attempt to quit using Cox proportional hazards analyses.

resultsAmong 1068 eligible participants followed over a median time of 3.1 years (interquartile range 1.2-6.8 years), 304 (29%) were prescribed smoking cessation medications. Multivariable factors positively associated with prescribed smoking cessation medications included year of first HOPS visit (adjusted hazard ratio (aHR) 1.09), having diagnoses of depression (aHR 1.39), or chronic obstructive pulmonary disease/emphysema (aHR 1.89). Among 464 people who smoked at baseline and had at least one ACASI survey, during a median follow-up time of 2.3 years (interquartile range 0.8-5.2 years), 163 (35%) attempted to quit smoking. Multivariable factors positively associated with first attempt to quit included year of first HOPS visit (aHR 1.24), having a diagnosis of depression (aHR 1.30) or bipolar disorder (aHR 1.62), and being prescribed smoking cessation medications (range aHR 2.62-aHR 5.97, depending on the medication), whereas having a diagnosis of psychosis (aHR 0.29), hypertension (aHR 0.41), or obesity (aHR 0.49) was inversely associated.

conclusionIn the HOPS, about one-third of smokers were prescribed smoking cessation medications, and of those who completed the risk behavior survey, one-third attempted to quit. Among incident comorbidities examined, time-updated depression was both positively associated with being prescribed smoking cessation medications and attempting to quit smoking. Our results highlight the need for better integration of smoking cessation and prevention programs into PWH care.