Is There an Association Between Cigarette Smoking and Advanced Liver Fibrosis in Smokers with HIV, Heavy Drinking and High Prevalence of HCV?

Abstract

Altres ajuts: National Institute on Alcohol Abuse and Alcoholism (U01AA020780, U24AA020779, U24AA020778); The Providence/Boston Center for AIDS Research (P30AI042853); Tennessee Center for AIDS Research (P30AI110527); National Plan on Drugs, Spain (grants No. 2020/024)

Background: Cigarette smoking has been associated with liver fibrosis in the setting of hepatitis C virus (HCV) infection but has not been studied among people with HIV (PWH) who consume alcohol. Methods: This is a cross-sectional study of PWH with heavy drinking and daily smoking in St. Petersburg, Russia. The primary independent variable was past 30-day cigarettes per day (cpd), and the secondary independent variable was pack-years at study entry. Advanced liver fibrosis was defined as FIB-4 > 3.25. Analyses were adjusted for gender, body mass index (BMI), past 30-day number of heavy drinking days, HCV and CD4 count. Results: Participants (n = 400) were two-thirds male (67.3%), young (median age 38 years), lean (median BMI 22), HCV antibody positive (84.5%) and not severely immune suppressed (median CD4 count 351). The median number of past-month cpd was 20 (IQR: 15-25), and the median pack-years was 24 (IQR: 17-31.8). The prevalence of advanced liver fibrosis was 11.3% (45/400). In the adjusted logistic regression analyses, we did not observe a significant association between cpd [middle (10.1-20 cigarettes) vs. lowest (5-10 cigarettes) category (adjusted odds ratio [aOR] (95% confidence interval [CI]): 1.06 (0.40-2.83), highest (>20.0 cigarettes) vs. lowest category aOR (95% CI): 0.65 (0.21-1.99), global p -value = 0.62]. The secondary analysis with pack-years yielded similar results [middle (20.1-30 pack-years) vs. lowest category (≤20 pack-years) aOR (95% CI): 0.81 (0.33-1.99), highest category (>30 pack-years) vs. lowest category aOR (95% CI): 0.91 (0.38-2.19); global p -value = 0.58]. Conclusions: In this Russian cohort of PWH, we did not detect an association between recent cigarette use or mean pack-years and advanced liver fibrosis.