Tobacco smoking and HIV-related immunologic and virologic response among individuals of the Canadian HIV Observational Cohort (CANOC)

ABSTRACT

We assessed the relationship between tobacco smoking and immunologic and virologic response among people living with HIV (PLWH) initiating combination antiretroviral therapy (cART) in the Canadian HIV Observational Cohort (CANOC). Positive immunologic and virologic response, respectively, were defined as ≥50 cells/mm³ CD4 count increase (CD4+) and viral suppression ≤50 copies/mL (VL+) within 6 months of cART initiation. Using multinomial regression, we examined the relationship between smoking, immunologic, and virologic response category. Model A adjusted for birth sex, baseline age, enrolling province, and era of cohort entry; models B and C further adjusted for neighbourhood level material deprivation and history of injection drug use (IDU), respectively. Among 4267 individuals (32.7%) with smoking status data, concordant positive (CD4+/VL+) response was achieved by 64.2% never, 66.9% former, and 59.4% current smokers. In the unadjusted analysis, current smoking was significantly associated with concordant negative response (odds ratio [OR] 1.85, 95% confidence interval [CI] 1.40–2.45). Similarly, models A and B showed an increased odds of concordant negative response in current smokers (adjusted OR [aOR] 1.78, 95% CI 1.32–2.39 and 1.74, 95% CI 1.29–2.34, respectively). The association between current smoking and concordant negative response was no longer significant in model C (aOR 1.18, 95%CI 0.85–1.65).

KEYWORDS:

• HIV
• tobacco smoking
• immunologic response
• virologic response

Acknowledgements

We would like to thank all of the study participants who allowed their data to be a part of the CANOC Collaboration. We would also like to acknowledge all of CANOC’s affiliated researchers: Principal Investigator: Robert Hogg (British Columbia Centre for Excellence in HIV/AIDS; Simon Fraser University); Site Principal Investigators: Ann N. Burchell [Ontario HIV Treatment Network (OHTN); University of Toronto; OHTN Cohort Study (OCS)], Curtis Cooper (University of Ottawa; OCS), Deborah Kelly (Memorial University of Newfoundland), Marina Klein (Montreal Chest Institute Immunodeficiency Service Cohort; McGill University), Mona Loutfy (University of Toronto; Maple Leaf Medical Clinic; OCS), Nima Machouf (Clinique Medicale l’Actuel; Universite de Montreal), Julio Montaner (British Columbia Centre for Excellence in HIV/AIDS; University of British Columbia), Janet Raboud (University of Toronto; University Health Network; OCS), Chris Tsoukas (McGill University), Stephen Sanche (University of Saskatchewan), Alexander Wong (University of Saskatchewan); Co-Principal Investigators: Tony Antoniou (St Michael’s Hospital; University of Toronto; Institute for Clinical Evaluative Sciences), Ahmed Bayoumi (St Michael’s Hospital; University of Toronto), Mark Hull (British Columbia Centre for Excellence in HIV/AIDS), Bohdan Nosyk (British Columbia Centre for Excellence in HIV/AIDS; Simon Fraser University); Co-Investigators: Angela Cescon (Northern Ontario School of Medicine), Michelle Cotterchio (Cancer Care Ontario; University of Toronto), Charlie Goldsmith (Simon Fraser University), Silvia Guillemi (British Columbia Centre for Excellence in HIV/AIDS; University of British Columbia), P. Richard Harrigan (British Columbia Centre for Excellence in HIV/AIDS; University of British Columbia), Marianne Harris (St Paul’s Hospital), Sean Hosein (Community AIDS Treatment Information Exchange (CATIE)), Sharon Johnston (Bruyere Research Institute; University of Ottawa), Claire Kendall (Bruyere Research Institute; University of Ottawa), Clare Liddy (Bruyere Research Institute; University of Ottawa), Viviane Lima (British Columbia Centre for Excellence in HIV/AIDS; University of British Columbia), David Moore (British Columbia Centre for Excellence in HIV/AIDS; University of British Columbia), Alexis Palmer (British Columbia Centre for Excellence in HIV/AIDS; Simon Fraser University), Sophie Patterson (British Columbia Centre for Excellence in HIV/AIDS; Simon Fraser University), Peter Phillips (British Columbia Centre for Excellence in HIV/ AIDS; University of British Columbia), Anita Rachlis (University of Toronto; OCS), Sean B. Rourke (University of Toronto; OCS), Hasina Samji (British Columbia Centre for Excellence in HIV/AIDS), Marek Smieja (McMaster University), Benoit Trottier (Clinique Medicale l’Actuel, Universit e de Montr eal), Mark Wainberg (McGill University; Lady Davis Institute for Medical Research), Sharon Walmsley (University Health Network; University of Toronto); Collaborators: Chris Archibald (Public Health Agency of Canada Centre for Communicable Diseases and Infection Control), Ken Clement (Canadian Aboriginal AIDS Network), Monique Doolittle-Romas (Canadian AIDS Society), Laurie Edmiston (Canadian Treatment Action Council), Sandra Gardner (OHTN; University of Toronto; OCS), Brian Huskins (Canadian Treatment Action Council), Jerry Lawless (University of Waterloo), Douglas Lee (University Health Network; University of Toronto; Institute for Clinical Evaluative Sciences (ICES)), Renee Masching (Canadian Aboriginal AIDS Network), Stephen Tattle (Canadian Working Group on HIV & Rehabilitation), Alireza Zahirieh (Sunnybrook Health Sciences Centre); Analysts and Staff: Claire Allen (Regina General Hospital), Nic Bacani (British Columbia Centre for Excellence in HIV/AIDS), Stryker Calvez (Saskatoon HIV/AIDS Research Endeavour (SHARE)), Guillaume Colley (British Columbia Centre for Excellence in HIV/AIDS), Jason Chia (British Columbia Centre for Excellence in HIV/AIDS), Daniel Corsi (The Ottawa Hospital Immunodeficiency Clinic; Ottawa Hospital Research Institute), Erin Ding (British Columbia Centre for Excellence in HIV/AIDS), Louise Gilbert (Immune Deficiency Treatment Centre), Nada Gataric (British Columbia Centre for Excellence in HIV/AIDS), Lucia Light (OHTN), David Mackie (The Ottawa Hospital), Costa Pexos (McGill University), Paul Sereda (British Columbia Centre for Excellence in HIV/AIDS), Susan Shurgold (British Columbia Centre for Excellence in HIV/AIDS), Leah Szadkowski (University Health Network), Chrissi Galanakis (Clinique M edicale L’Actuel), Jason Trigg (British Columbia Centre for Excellence in HIV/AIDS), Monica Ye (British Columbia Centre for Excellence in HIV/AIDS), Benita Yip (British Columbia Centre for Excellence in HIV/AIDS), Jaime Younger (University Health Network), and Julia Zhu (British Columbia Centre for Excellence in HIV/AIDS).

Disclosure statement

ARM, KWK, JT, MY, PS, TM, NB, NA, AW, MH, CC, KS, and RSH have no conflicts to disclose. RT reports membership on an advisory board for Gilead, Merck, and ViiV Healthcare; research grants from Gilead, Merck, and ViiV Healthcare; participation in clinical trials of AbbVie, Gilead, GSK/ViiV Healthcare, Janssen, and Merck; all outside the submitted work. MBK reports grants for investigator-initiated studies from ViiV Healthcare, Merck, AbbVie, and Gilead; research grants from Janssen; personal fees from ViiV Healthcare, Merck, AbbVie, and Gilead; all outside the submitted work.

Additional information

Funding

CANOC is funded by the Canadian Institutes of Health Research (CIHR) through a Centres Grant (CIHR#02684); two Operating Grants (CIHR#134047, CIHR#136882); a Foundation Grant (CIHR#143342); in collaboration with the Canadian HIV Trials Network, Canadian Institutes of Health Research (CTN#242). The funders had no role in study design, data collection, analysis, interpretation, and decision to publish.