Factors associated with smoking in HIV-infected youth in the LEGACY Cohort

Background: A faster decrease in CD4 counts has been associated with smoking in HIV-infected adults. We described the prevalence of, and clinical and psychosocial factors associated with smoking among HIV-infected youth.

Methods: We analyzed data from LEGACY, a CDC-sponsored cohort study (N = 1,085; aged 11-25 years in 2006). We defined “smokers” as participants with medical record documentation of smoking tobacco, marijuana, and/or crack. Univariate and multivariable logistic regressions were performed.

Results: Of 1,085 HIV-infected youth (median age 16 years, 55% female, 65% black and 26% Hispanic), 136 (13%) were smokers: 81% smoked tobacco, 57% smoked marijuana, 3% smoked crack, and 36% smoked more than one substance type. Smokers, compared with nonsmokers, were more likely to be male or older; to have lower median CD4+ counts, higher median viral loads (VL); > 1 AIDS-Defining Condition (ADC); and less likely to be receiving HAART (all p<0.05). After adjusting for age, mode of HIV transmission, and HAART use, factors associated with smoking included having a CD4+ count <200cells/mm3 (adjusted odds ratio [AOR] 3.1; 95% confidence interval [CI] 1.5-5.4), a VL >100,000 copies/ml (AOR 2.3; CI 1.1-5.0), or an ADC (AOR 2.4; CI 1.3-4.4). Being sexually active (AOR 4.3; CI 2.7-6.8), homeless (AOR 5.6; CI 1.6-19.4), or incarcerated (AOR 2.7; CI 1.1-6.7), or having alcohol problems (AOR 14.7; CI 2.7-80.2) were also significantly associated with smoking.

Conclusion: Smoking was associated with poorer immunologic and virologic status. Associated psychosocial factors must be considered in developing anti-smoking interventions in HIV-infected youth.