Differences in Cognition and Smoking Abstinence Rates Among People With and Without HIV Who Smoke

High rates of smoking among people with HIV (PWH) persist and may be due to HIV-associated neurocognitive disorders exacerbating abstinence-induced cognitive deficits, leading to higher risk of relapse. This study assessed differences in smoking abstinence rates and abstinence-induced cognitive deficits among PWH and people without (PWOH).

In this prospective observational design (NCT03169101), treatment-seeking adults completed two laboratory sessions during a pre-quit phase to assess cognition: once following 24h abstinence and once smoking-as-usual. Cognition was measured through response inhibition, working memory, and verbal memory tasks. All received standard smoking cessation treatment over 8 weeks (i.e., counseling, nicotine patch). Point-prevalence abstinence was assessed at end-of-treatment.

Our sample included 210 participants (38.1% PWH; 61.9% PWOH), who were mostly male (59.5%) and Black/African-American (76.7%). No significant HIV status by abstinence condition interactions emerged for any cognitive outcome (all ps > .4). There were significant abstinence-induced deficits in response inhibition (p = .02), working memory response time (p = .005), and verbal memory (p=<.001). No significant differences emerged in abstinence rates between PWH and PWOH (31.2%, 32.3%, respectively; OR = 1.26, 95% CI: 0.67, 2.39, p = .48).

Despite prior research suggesting differences in abstinence rates and cognition between PWH and PWOH who smoke, hypotheses were not supported. However, this is one of a few studies to directly compare people with and without HIV in a rigorously designed mechanistic smoking cessation study. Given that cognition does not appear to play a primary role in smoking among PWH, more work is needed to understand the mechanisms driving disproportionate smoking rates among PWH.