Metabolic syndrome and population attributable risk among HIV/AIDS patients: comparison between NCEP-ATPIII,IDF and AHA/NHLBI definitions

Background

Metabolic Syndrome (MetS) is based on the same individual components, but has received several amendments to the original definition. In this study, we verified the prevalence of metabolic syndrome according to different criteria, and the impact of each component on the diagnostic.

Methods

This cross-sectional study enrolled HIV infected patients from a HIV/AIDS reference Center in southern Brazil. Metabolic syndrome was identified according to the National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (NCEP-ATPIII), the International Diabetes Federation (IDF) and the American Heart Association/National Heart, Lung and Blood Institute (AHA/NHLBI) criteria, and using a standardized questionnaire and blood testing.

Results

A sample of 1240, out of 1295, HIV-infected patients was enrolled. Males were on average older, more educated, and had shorter time since the HIV diagnosis. The population attributable risk (PAR) for waist circumference explained 80% of the prevalence among men and women (AHA/NHLBI criteria). Triglycerides had the highest impact on prevalence of metabolic syndrome according to all criteria, independently of age, skin color and HAART use, among men.

Conclusions

In this large sample of HIV infected patients, the overall prevalence of metabolic syndrome, under either classification, was noticeable and the AHA/NHLBI definition accounted for the highest prevalence.

     

Sex Differences in HIV Infection

Purpose of Review

This review will outline the multilevel effects of biological sex on HIV acquisition, pathogenesis, treatment response, and prospects for cure. Potential mechanisms will be discussed along with future research directions.

Recent Findings

HIV acquisition risk is modified by sex hormones and the vaginal microbiome, with the latter acting through both inflammation and local metabolism of pre-exposure prophylaxis drugs. Female sex associates with enhanced risk for non-AIDS morbidities including cardiovascular and cerebrovascular disease, suggesting different inflammatory profiles in men and women. Data from research on HIV cure points to sex differences in viral reservoir dynamics and a direct role for sex hormones in latency maintenance.

Summary

Biological sex remains an important variable in determining the risk of HIV infection and subsequent viral pathogenesis, and emerging data suggest sex differences relevant to curative interventions. Recruitment of women in HIV clinical research is a pathway to both optimize care for women and to identify novel therapeutics for use in both men and women.

     

HIV sero-discordance among married HIV patients initiating anti-retroviral therapy in northern Vietnam

Background

In many countries in Asia, the HIV epidemic is in a concentrated phase, with high prevalence in certain risk groups, such as men who inject drugs. There is also a rapid increase of HIV among women. The latter might be due to high levels of sero-discordant couples and increasing transmission from male to female partners over time.

Methods

All adult married patients initiating antiretroviral treatment at four out-patient clinics in Quang Ninh province in north-eastern Vietnam between 2007 and 2009 were asked to participate in the study. Clinical information was extracted from patients’ records, and a structured questionnaire was used to collect social, demographic and economic data.

Results

Two hundred eighty-eight married patients for whom information on the HIV status of their spouse was available were included in the study. Overall, the sero-discordance rate was 58%. The sero-discordance rate was significantly higher among married males, 71% had spouses not infected, than married females, of whom 18% had spouses not infected. Other factors associated with a high rate of sero-discordance were injection drug use (IDU) history, tuberculosis (TB) history and the availability of voluntary counselling and testing (VCT) in residential locations. High sero-concordance was associated with college/university education.

Conclusion

The sero-discordance was significantly higher among married males than married females. Other factors also related to high sero-discordance were history of IDU, history of TB and the availability of VCT in residential locations. In contrast, college/university education and female sex were significantly related to low sero-discordance. To contain the increasing HIV prevalence among women, measures should be taken to prevent transmission among sero-discordant couples. Trial registration NCT01433601

     

Persistent trigeminal artery: a cross-sectional study based on over 3 years conventional angiography,CT angiography and MR angiography images

Purpose

The trigeminal artery is one of the four primitive anastomosis established between the internal carotid artery and the vertebrobasilar system that regresses at the sixth week of embryonic development. Its persistence in adult life (PTA) is usually found incidentally. The aim of this study is to determine its prevalence, main characteristics and clinical significance.

Methods

A cross-sectional study was performed over the last 3 years, 2012–2014, to analyze images performed on conventional angiography, CT angiography and MR angiography of patients who attended the Neuroradiology Department of the Hospital Universitario Doce de Octubre in Madrid, Spain, to control their underlying pathology.

Results

Nine cases of PTA were found (prevalence 0.37 %, two men, seven women; three right, six left; age range 13–88 years). Eight PTA emerged from the cavernous ICA and one from the petrous segment. Six cases were lateral or petrosal type and one was medial or sphenoidal type. The whole PTAs anastomosed the BA, six at the middle third and three at the distal third. Weon et al.’s type 3 was predominant. CVD incidence was 55.6 % and aneurysm incidence was 22 %.

Conclusions

PTA prevalence was similar to those previously reported, being commonly left-sided, Salas et al.’s lateral or petrosal type, Weon et al.’s type 3 and with no gender predominance. CVD and aneurysms incidence in the presence of a PTA were higher than in general population. Its anatomical relations make it essential to consider its presence and directional blood flow when planning endovascular and neurosurgical treatments.

     

Examining the Associations Between Overeating,Disinhibition, and Hunger in a Nonclinical Sample of College Women

Background

Binge eating (BE) has long been identified as a correlate of overweight and obesity. However, less empirical attention has been given to overeating with and without loss of control (LOC) in nonclinical samples.

Purpose

The goal of the present study was to examine the association of (1) established correlates of BE, namely, weight and shape concerns, dietary restraint, and negative affect, and (2) three additional correlates, disinhibition, hunger, and interoceptive awareness (IA), to overeating in a nonclinical sample of college women.

Method

Female students (n?=?1,447) aged 18 to 21 years recruited from colleges in three Canadian metropolitan areas completed self-report questionnaires in class to assess sociodemographic and anthropomorphic characteristics, overeating, LOC, dietary restraint, negative affect, weight and shape concerns, IA, disinhibition, and hunger.

Results

The established correlates of BE were significant correlates of all types of overeating and explained 33 % of the variance. Disinhibition was the most strongly associated correlate of overeating.

Conclusions

Findings suggest that established correlates of BE are associated with other types of overeating such as objective overeating (OOE), as are disinhibition and hunger.

     

Work-Home Interference,Perceived Total Workload,and the Risk of Future Sickness Absence Due to Stress-Related Mental Diagnoses Among Women and Men: a Prospective Twin Study

Purpose

Work-home interference has been proposed as an important explanation for sickness absence (SA). Previous studies show mixed results, have not accounted for familial factors (genetics and shared everyday environment), or investigated diagnosis specific SA. The aim was to study whether work-home interference and perceived total workload predict SA due to stress-related mental diagnoses, or SA due to other mental diagnoses, among women and men, when adjusting for various confounders and familial factors.

Methods

This study included 11,916 twins, 19–47 years (49% women). Data on work-to-home and home-to-work conflicts, perceived total workload, and relevant confounders were derived from a 2005 survey, and national register data on SA spells until 2013 were obtained. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated. Discordant twin pair design was applied to adjust for familial factors.

Results

Each one unit increase in work-to-home and home-to-work conflicts, and perceived total workload was associated with higher odds for SA due to stress-related mental diagnoses and to SA due to other mental diagnoses among women, when adjusting for sociodemographic factors (ORs 1.15–1.31). Including health or familial factors, no associations remained. For men, each one unit increase in work-to-home conflicts was associated with higher odds for SA due to stress-related diagnoses (ORs 1.23–1.35), independently of confounders.

Conclusion

Work-to-home conflict was independently associated with future SA due to stress-related diagnoses among men only. Health- and work-related factors seem to be important confounders when researching work-home interference, perceived total workload, and SA. Not including such confounders involves risking drawing incorrect conclusions. Further studies are needed to confirm sex differences and whether genetic factors are important for the associations studied.

     

Change in Work–Time Control and Work–Home Interference Among Swedish Working Men and Women: Findings from the SLOSH Cohort Study

Purpose

The aim is to study the influence of change in work–time control (WTC) on work–home interference (WHI) while adjusting for other work-related factors, demographics, changes at work and WHI at baseline among women and men. An additional aim was to explore sex differences in the relation between change in WTC and WHI.

Methods

The study included working participants of the Swedish Longitudinal Occupational Survey of Health (SLOSH) study of the third (2010) and fourth (2012) waves (n?=?5440). Based on a seven-item index, four groups of WTC were formed: stable high (40 %), stable low (42 %), increasing (9 %), or decreasing (9 %) WTC over the 2 years. WHI was measured by four items and individuals were categorised in whether suffering or not suffering of WHI. Sex-stratified logistic regression analyses with 95 % confidence intervals (CI) were used to estimate the odds of experiencing WHI by change in WTC.

Results

Controlling for demographics and work-related factors, women with stable low (OR?=?1.46; 95 % CI 1.14–1.88) and women and men with decreasing WTC (women OR?=?1.99; 95 % CI 1.38–2.85; men OR?=?1.80; 95 % CI 1.18–2.73) had higher odds of WHI than those with a stable high WTC. Additionally, adjusting for changes at work and WHI at baseline did not alter the results substantially. Interaction analysis did not reveal any significant sex difference in the relation between WTC and WHI.

Conclusions

For both women and men decreased and for women only, low control over working hours resulted in WHI also after adjusting for work-related factors and demographics.

     

Socioeconomic disparities in intimate partner violence against Native American women: a cross-sectional study

Background

Intimate partner violence (IPV) against women is a global public health problem, yet data on IPV against Native American women are extremely limited. We conducted a cross-sectional study of Native American women to determine prevalence of lifetime and past-year IPV and partner injury; examine IPV in relation to pregnancy; and assess demographic and socioeconomic correlates of past-year IPV.

Methods

Participants were recruited from a tribally-operated clinic serving low-income pregnant and childbearing women in southwest Oklahoma. A self-administered survey was completed by 312 Native American women (96% response rate) attending the clinic from June through August 1997. Lifetime and past-year IPV were measured using modified 18-item Conflict Tactics Scales. A socioeconomic index was created based on partner's education, public assistance receipt, and poverty level.

Results

More than half (58.7%) of participants reported lifetime physical and/or sexual IPV; 39.1% experienced severe physical IPV; 12.2% reported partner-forced sexual activity; and 40.1% reported lifetime partner-perpetrated injuries. A total of 273 women had a spouse or boyfriend during the previous 12 months (although all participants were Native American, 59.0% of partners were non-Native). Among these women, past-year prevalence was 30.1% for physical and/or sexual IPV; 15.8% for severe physical IPV; 3.3% for forced partner-perpetrated sexual activity; and 16.4% for intimate partner injury. Reported IPV prevalence during pregnancy was 9.3%. Pregnancy was not associated with past-year IPV (odds ratio = 0.9). Past-year IPV prevalence was 42.8% among women scoring low on the socioeconomic index, compared with 10.1% among the reference group. After adjusting for age, relationship status, and household size, low socioeconomic index remained strongly associated with past-year IPV (odds ratio = 5.0; 95% confidence interval: 2.4, 10.7).

Conclusions

Native American women in our sample experienced exceptionally high rates of lifetime and past-year IPV. Additionally, within this low-income sample, there was strong evidence of socioeconomic variability in IPV. Further research should determine prevalence of IPV against Native American women from diverse tribes and regions, and examine pathways through which socioeconomic disadvantage may increase their IPV risk.

     

Increases in condomless chemsex associated with HIV acquisition in MSM but not heterosexuals attending a HIV testing center in Antwerp,Belgium

Background

It has been speculated that the prevalence of chemsex is increasing in men who have sex with men and that this may be playing a role in the spread of HIV.

Methods

We assessed if the prevalence of reported chemsex was increasing and if chemsex was associated with HIV infection in clients attending the ‘Helpcenter’, Antwerp, between 2011 and 2017. This is a HIV/STI testing center that offers HIV/STI testing to HIV-uninfected individuals from key populations including MSM.

Results

We found an increase in the reporting of condomless sex associated with the use of a number of drugs, including ecstasy, amphetamines, GHB and cocaine in MSM (from 8 to 17%) but not in heterosexuals. Reporting condomless chemsex was associated with HIV infection (adjusted odds ratio 5.7 [95% confidence interval 3.2–10.4]).

Conclusions

Our findings provide further evidence of the importance of asking MSM clients about the use of psychoactive substances during consultations and tailoring interventions such as pre exposure prophylaxis, more frequent STI screening and substance abuse counseling accordingly.

     

Analysis of self-report and biochemically verified tobacco abstinence outcomes with missing data: a sensitivity analysis using two-stage imputation

Background

Missing data are common in tobacco studies. It is well known that from the observed data alone, it is impossible to distinguish between missing mechanisms such as missing at random (MAR) and missing not at random (MNAR). In this paper, we propose a sensitivity analysis method to accommodate different missing mechanisms in cessation outcomes determined by self-report and urine validation results.

Methods

We propose a two-stage imputation procedure, allowing survey and urine data to be missing under different mechanisms. The motivating data were from a tobacco cessation trial examining the effects of the extended vs. standard Quit and Win contests and counseling vs. no counseling under a 2-by-2 factorial design. The primary outcome was 6-month biochemically verified tobacco abstinence.

Results

Our proposed method covers a wide spectrum of missing scenarios, including the widely adopted “missing?=?smoking” imputation by assuming a perfect smoking-missing correlation (an extreme case of MNAR), the MAR case by assuming a zero smoking-missing correlation, and many more in between. The analysis of the data example shows that the estimated effects of the studied interventions are sensitive to the different missing assumptions on the survey and urine data.

Conclusions

Sensitivity analysis has played a crucial role in assessing the robustness of the findings in clinical trials with missing data. The proposed method provides an effective tool for analyzing missing data introduced at two different stages of outcome assessment, the self-report and validation time. Our methods are applicable to trials studying biochemically verified abstinence from alcohol and other substances.

     

HIV Prevention Among Transgender Populations: Knowledge Gaps and Evidence for Action

Purpose of Review

The purpose of this review is to summarize the available evidence-based HIV prevention interventions tailored for transgender people.

Recent Findings

A limited number of evidence-based HIV prevention interventions have been tested with transgender populations. Most existing interventions target behavior change among transgender women, with only one HIV prevention program evaluated for transgender men. Studies addressing biomedical interventions for transgender women are ongoing. Few interventions address social and structural barriers to HIV prevention, such as stigma, discrimination, and poverty.

Summary

Evidence-based multi-level interventions that address the structural, biomedical, and behavioral risks for HIV among transgender populations, including transgender men, are needed to address disparities in HIV prevalence. Future research should address not only pre-exposure prophylaxis uptake and condom use but also structural barriers that limit access to these prevention strategies.

     

Risk of gestational hypertension and preeclampsia in women who discontinued or continued antidepressant medication use during pregnancy

Purpose

This study aimed to examine the association between discontinued and continued use of antidepressants and risk for gestational hypertension (GH) and preeclampsia (PE).

Methods

Data from the MotherToBaby pregnancy studies from 2004 to 2014 were analyzed to compare women who discontinued antidepressant use ?20 weeks of gestation (discontinuers) and women who continued antidepressant use ≥20 weeks of gestation (continuers) to non-users for risk of GH (blood pressure ≥140/90 mmHg on two or more occasions at ≥20 weeks of gestation) and PE (GH with proteinuria). Maternal data, including exposures and study outcomes, were collected through multiple phone interviews. Medical records were used to validate outcomes. Odds ratios (ORs) and 95 % confidence intervals were estimated using logistic regression. Risk for GH and PE were also assessed within antidepressant drug classes.

Results

Data from 3471 women were analyzed. Continuers were significantly at risk for GH (adjusted odds ratios (aOR) 1.83; 95 % CI 1.05, 3.21) after adjustment. Analyses by drug class showed that continued use of serotonin-norepinephrine reuptake inhibitors (SNRI) increased risk for GH; however, of the 21 women who continued to use SNRI, only 3 developed GH. Continuers who used two or more antidepressant drug classes had increased risk for PE. Selective serotonin reuptake inhibitors or other antidepressant use was not associated with increased risk for GH or PE. No significant associations with PE or GH were found for discontinuers.

Conclusions

Results suggest that women who continued to use antidepressants in the second half of pregnancy are at risk for GH and PE. No significant association was found among discontinuers.

     

Cost and cost-effectiveness of voluntary medical male circumcision in street-connected youth: findings from an education-based pilot intervention in Eldoret,Kenya

Background

Voluntary medical male circumcision (VMMC) is a critical component of HIV prevention. VMMC policies have achieved initial targets in adult men yet continue to fall short in reaching younger men and adolescents.

Setting

We present the cost and scale-up implications of an education-based, VMMC intervention for adolescent street-connected males, for whom the street has become their home and/or source of livelihood. The intervention was piloted as part of the Engaging Street Youth in HIV Interventions Project in Eldoret, Kenya.

Methods

We used a micro-costing approach to estimate the average cost of a VMMC intervention in 116 street-connected youth. Average cost was estimated per individual and per cohort by dividing total cost per intervention by number of clients accessing the intervention over a 30-day period. Total average costs included direct and support procedure costs, educational costs, and direct research costs. Cost-effectiveness was measured in cost per DALYs averted over a 5 and 10-year period.

Results

The total cost of the intervention was $12,526 over the 30-day period, with an average cost per individual of $108. The direct VMMC procedure cost was approximately $9 per individual. Personnel costs contributed the greatest percentage to the total intervention cost (38.2%), with mentors and social workers representing the highest wage earners. Retreat-related and education costs contributed 51% and 13% respectively to the total average cost, with surgical equipment costs contributing less than 1%. At a cost of $108 per individual, the intervention averted 60166 DALYs in 5 years resulting in a cost per DALY averted of $267.

Conclusion

The VMMC intervention was highly cost-effective in Kenya, despite the additional costs incurred to reach SCY. Further scale-up may be warranted to effectively apply this intervention in comparable populations.

     

Larger and More Prominent Graphic Health Warnings on Plain-Packaged Tobacco Products and Avoidant Responses in Current Smokers: a Qualitative Study

Background

The introduction of tobacco plain packaging legislation in Australia meant that all tobacco products were to be sold in plain dark-brown packaging with 75 % front-of-pack graphic health warnings and standardised font type and size for brand name and product variant. The change in the size and prominence of the warnings has been proposed as a reason for behaviour change in smokers in terms of increased intentions to quit and quit attempts.

Purpose

The current research examined attitudes and beliefs of cigarette smokers toward the increased size and prominence of the warnings and effects on their behaviour.

Method

Participants (N?=?160) completed open-ended responses to questions on beliefs, attitudes and responses to plain packaging. Responses were subjected to inductive thematic content analysis for key themes.

Results

Four themes emerged from the analysis: emotional response to packaging, scepticism of health warnings, warnings and cessation behaviour, and avoidant coping behaviours. Participants reported increased negative emotional responses to the packaging and made specific reference to the graphic health warnings. Some participants attempted to discredit the messages. Others reported increased intentions to quit or quitting attempts. There were pervasive reports of avoidant responses including covering or hiding the warnings.

Conclusion

Consistent with theories of illness perceptions and coping, current findings indicate that the larger, prominent graphic health warnings on plain-packaged tobacco products had pervasive effects on threat perceptions and subsequent behavioural responses. While some of the reported responses were adaptive (e.g. attempts to quit), others were maladaptive (e.g. avoiding the warnings).

     

Treatment of Hepatitis C during Pregnancy-Weighing the Risks and Benefits in Contrast to HIV

Purpose of Review

Increasing hepatitis C virus (HCV) cases over the past decade have raised concerns about subsequent increased cases in infants due to mother to child transmission (MTCT). Many are reminded of the early days of HIV and the rationale for using antiretroviral agents during pregnancy.

Recent Findings

Direct-acting antivirals (DAAs) that are highly potent, all-oral, short-duration regimens that cure HCV have led many to consider what it would entail to use DAAs for pregnant women. Considering HIV and Hepatitis B virus (HBV) as two infections with MTCT to draw lessons from, DAA use to interrupt HCV MTCT comes with risks, costs, and many potential benefits.

Summary

When considering how to effectively curb the current epidemic of HCV in the US population, using DAAs to treat pregnant women with HCV offers potential benefits to the mother immediately, to the pair in the short-term and to the child, family, and society over a lifetime.

     

Tinnitus,Traumatic Brain Injury,and Posttraumatic Stress Disorder in the Military

Purpose

Acoustic trauma is more prevalent in military settings, especially among individuals with combat-related military occupational specialties. Gunfire, improvised explosive devices, and mortar explosions are a few examples that may cause hearing degradation and tinnitus. It is possible that the same events that are associated with auditory problems can cause traumatic brain injury (TBI) and posttraumatic stress disorder (PTSD).

Method

This paper reviews the distinct and overlapping symptoms of tinnitus, TBI, and PTSD, and how these disorders interact to synergistically promote negative outcomes.

Results

Tinnitus may serve as a significant contributor to symptoms of TBI and PTSD. Therefore, tinnitus subtypes could be identified as physiologically or psychologically based, or both.

Conclusions

Additional research is warranted to determine the common and unique symptoms and associated neurological pathways of tinnitus, TBI, and PTSD. Brief treatment recommendations are provided, including a multidisciplinary approach for the physical and psychological distress associated with tinnitus.

     

Through thick and thin?

Background

A good romantic relationship quality increases resilience against mental and physical health problems. Regarding correlates of relationship quality, research has focused mostly on attachment style and personality traits such as the Big Five.

Objective

The current study aims to find further predictors of a good relationship quality, such as sleep, demographics, and the boundary concept.

Materials and methods

For the study, 336 subjects were recruited, most of them women (79.76%). Only participants who were in a relationship were included in the analyses (N?=?216). The effects of sleep (Pittsburgh Sleep Quality Index, PSQI), demographics, and thin or thick boundaries (Boundary Personality Questionnaire, BPQ) on relationship quality (Partnerschaftsfragebogen—Kurzversion, PFB-K) were assessed using multiple regression.

Results

Age and thickness of boundaries were significantly connected with relationship quality. Sleep quality, gender, body mass index, and accommodation were not related to relationship quality.

Conclusion

The current study confirms the importance of age and provides new insight into the effects of boundaries in terms of relationship quality. Methodological limitations (e.g., homogenous and healthy sample) might compromise the findings regarding sleep. Future studies should include a more diverse sample and investigate further correlates of the boundary concept.

     

The Influence of Cervicovaginal Microbiota on Mucosal Immunity and Prophylaxis in the Battle against HIV

Purpose of Review

Young women in sub-Saharan Africa bear a disproportionate burden of the global HIV epidemic. In this review, we examine how cervicovaginal microbiota modulate structural and immune defenses in the female genital tract and influence HIV susceptibility.

Recent Findings

Highly diverse, anaerobic cervicovaginal microbiota prevalent in sub-Saharan African women increase HIV acquisition risk by over fourfold. These bacteria weaken the barrier properties of the vaginal mucosa and increase local inflammation and HIV target cell recruitment, creating an environment permissive to HIV. These communities also diminish the prophylactic efficacy of topical tenofovir and therefore may modulate both biological susceptibility to HIV and the effectiveness of pre-exposure prophylaxis (PrEP).

Summary

Cervicovaginal bacteria influence multiple reproductive health outcomes, including HIV acquisition. High-diversity, low Lactobacillus abundance cervicovaginal communities prevalent in many regions with high HIV incidence are associated with increased HIV susceptibility. A better understanding of the host-microbial interactions mediating this risk is important to reduce HIV infections, particularly among women living in sub-Saharan Africa.

     

The Moderating Effect of Smoking Status on the Relation between Anxiety Sensitivity,Sexual Compulsivity,and Suicidality among People with HIV/AIDS

Purpose

The present study examined the moderating effect of cigarette smoking status on the relation between anxiety sensitivity (fear of the expected negative consequences of anxiety and bodily sensations) and hazardous alcohol consumption, sexual compulsivity, and suicidality.

Method

A series of multiple hierarchical regressions were used to test the proposed hypothesis among a sample of 94 persons living with HIV/AIDS in the USA (64.5 % male, M _age?=?48.3, SD?=?7.5). Fifty-seven percent of the participants (n?=?54) reported past-month smoking.

Results

The results indicated that those who reported smoking and had higher anxiety sensitivity demonstrated the highest rates of hazardous alcohol use, sexual compulsivity, and suicidality. Simple slope analyses indicated that anxiety sensitivity was associated with higher rates of hazardous alcohol use, sexual compulsivity, and suicidality among individuals who reported past-month smoking, but not among individuals who did not smoke.

Conclusion

The present results suggest that smoking status moderates the relation between anxiety sensitivity and hazardous alcohol use, sexual compulsivity, and suicidality among persons living with HIV/AIDS. These data add to a growing literature, suggesting that smoking has a negative impact among persons living with HIV/AIDS, which extends beyond physical health problems to a variety of clinically significant behavioral health sequelae.