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

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. 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. 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 -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 -value = 0.58]. In this Russian cohort of PWH, we did not detect an association between recent cigarette use or mean pack-years and advanced liver fibrosis.