Method: Patient reported outcomes (PROs) were analyzed of patients living with HIV/HCV co-infection (n=313) who presented for clinical evaluation and treatment of HCV between 2013-2017 at a university-affiliated clinic. Patients completed several questionnaires on tobacco smoking, alcohol and substance use, and depression and anxiety. Laboratory and other medical data were extracted from electronic medical records. Binomial logistic regression was used to identify predictors of tobacco smoking.
Results: The mean age was 52±11.1 years, and the majority of patients were African American (56%) and insured (87%). Patients were aware of their HCV diagnosis for 7±7.3 years and aware of their HIV diagnosis for 14±9.3 years. The prevalence of tobacco use in patients with HIV/HCV co-infection was 48%. Compared to non-smokers, a higher proportion of tobacco smokers had substance use disorders (29% vs. 44%, p=0.00) and concurrent alcohol and substance use (21% vs. 40%, p=0.000). In the multivariate analysis, concurrent alcohol and substance use (OR=3.059, p=0.011) was positively associated with tobacco smoking.
Discussion: This study identified major disparities in the prevalence of tobacco smoking among patients with HCV/HIV co-infection compared to the national use rate (48% vs. 15%), and tobacco smoking was positively associated with alcohol or substance use and concurrent alcohol and substance use. Findings suggest that tobacco smoking cessation interventions may be suboptimal without integrative behavioral approaches to reduce both alcohol and substance use in patients living with HIV/HCV co-infection. Otherwise, patients with HIV/HCV co-infection may be at greater risk for liver cancer compared to patients with HIV or HCV mono-infection. Clinical social workers who provide health care services to this respective patient population are encouraged to consider intervention approaches that prioritize tobacco use and alcohol and substance use reduction and cessation.