Inflammation in Relation to Intensity and Duration of Cigarette Smoking Among People Living with HIV
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ORIGINAL PAPER
Inflammation in Relation to Intensity and Duration of Cigarette Smoking Among People Living with HIV Krishna C. Poudel1,2 · Kalpana Poudel‑Tandukar3 · Elizabeth R. Bertone‑Johnson4,5 · Penelope Pekow5 · Damon J. Vidrine6 Accepted: 22 September 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Both inflammation and smoking are independent predictors of morbidity and mortality among people living with HIV (PLHIV). As smoking burden is likely to exacerbate inflammation, we tested the hypothesis that higher intensity and longer duration of smoking are positively associated with C-reactive protein (CRP, an inflammatory marker) among 284 PLHIV in Kathmandu, Nepal. We measured smoking status, intensity of smoking, smoking duration, and CRP concentrations. In total, 22.9% of never smokers, 24.3% former smokers, and 34.1% current smokers had high CRP (> 3 mg/l). The median intensity and duration of smoking were 12 (cigarettes/day) and 19 years, respectively. Intensity of smoking (beta for increase in number of cigarettes/day: β = 0.245; p = 0.017), smoking duration (beta for 1-year increase in smoking: β = 0.341; p = 0.013), and pack-years of smoking (beta for 1-pack-years of smoking increase: β = 0.351; p = 0.002) were each positively associated with CRP concentrations. While quitting is important, reducing the intensity and duration of smoking until quitting might be helpful in reducing the levels of inflammation, thereby in mitigating HIV-related harms. Keywords Smoking · HIV · HIV/AIDS · Inflammation · C-reactive protein
Introduction
* Krishna C. Poudel [email protected] 1
Department of Health Promotion and Policy, School of Public Health and Health Sciences, University of Massachusetts Amherst, 715 North Pleasant St., 301 Arnold House, Amherst, MA 01003‑9304, USA
2
Institute for Global Health, University of Massachusetts Amherst, Amherst, MA, USA
3
College of Nursing, University of Massachusetts Amherst, Amherst, MA, USA
4
Department of Health Promotion and Policy, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, MA, USA
5
Department of Biostatistics & Epidemiology, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, MA, USA
6
Department of Health Outcomes and Behavior, Moffit Cancer Center, Tampa, FL, USA
People living with HIV (PLHIV) exhibit 2–3 times higher rates of tobacco use than the general population [1–3] and those who use tobacco are vulnerable to tobacco-related harms. Compared to non-smoking PLHIV, for example, cigarette smoking independently reduces life expectancy for PLHIV [4] and increases the risk of several opportunistic infections including tuberculosis (TB) [5, 6], pneumothorax [7], certain cancers [8–10], and increased viral replication [11, 12] thereby decreasing response to highly active antiretroviral therapy (HAART) [13]. PLHIV receiving HAART have greater mortality risk from tobacco (up to 60%) than from HIV-related factors
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