Tobacco Consequences in Youth Living With HIV


Tobacco is the leading cause of premature mortality among adults living with HIV.

Tobacco remains the single largest preventable cause of death in the United States. Yet, 1 in 5 Americans still smoke. Smoking prevalence is more than double in adults living with HIV. Studies in adults with HIV consistently find tobacco smoking creates negative outcomes, including HIV disease progression, and AIDS-related morbidity. Tobacco is the leading cause of premature mortality among adults living with HIV.

Factors associated with tobacco use behaviors in adults include younger age, low socioeconomic status, co-occurring substance use, and psychological distress. Previous studies in youth living with HIV (YLWH) haven’t examined factors associated with tobacco use behaviors.

The journal AIDS and Behavior published a study in HIV patients between 13 and 24 years old, finding daily tobacco use significantly decreases durable viral suppression, and often coincides with other substance abuse. This study in 820 youth living with HIV (YLWH) had two purposes:

  • Identify psychosocial behavioral factors associated with tobacco.
  • Examine the association between smoking behaviors and sustained viral suppression, after statistically adjusting for known factors linked to barriers to viral suppression.

The significant connection between YLWH smoking and HIV disease progression is consistent with prior findings in adult populations.

It is important to note YLWH commonly abuse other substances, which may make them vulnerable to suboptimal antiretroviral therapy (ART) adherence. Patients self-reported ART adherence, which is subject to social desirability and recall bias.

This study supports the hypothesis that tobacco smoking has direct physiological effects on HIV disease progression, but further research is necessary for certainty.

Other factors in YLWH that were associated with a detectable viral load include unstable housing or homelessness, and history of criminal justice involvement. These structural factors can cause significant social and environmental distress in patients, so they may particularly benefit from tobacco screening and interventions.

Between 33% and 38% of YLWH use tobacco. Pharmacists should target this patient population at risk for insufficient viral suppression, and provide smoking cessation education.

Sara E. Miller is a 2108 PharmD candidate at the University of Connecticut.


Gamarel KE, Westfall AO, Lally MA, et al. Tobacco use and sustained viral suppression in youth living with HIV. AIDS and Behavior. 2018;22(6):2018-2025.

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