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Is Abstinence from Alcohol and Smoking Associated with Less Anxiety and Depressive Symptoms Among People with HIV?

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Abstract

Achieving abstinence from alcohol, tobacco, or both may improve mental health, but is understudied in people with HIV (PWH). The St PETER HIV randomized clinical trial compared varenicline, cytisine, and nicotine replacement therapy on alcohol and smoking behavior among 400 PWH in Russia. The primary exposure was thirty-day point prevalence abstinence (PPA) from (1) alcohol, (2) smoking, (3) both, or (4) neither and was assessed at 1, 3, 6 and 12-months as were the study outcomes of anxiety (GAD-7) and depressive (CES-D) symptoms. The primary aim was to examine the association between smoking and/or alcohol abstinence and subsequent symptoms of depression and anxiety. Primary analysis used repeated measures generalized linear modeling to relate PPA with mental health scores across time. In secondary analyses, Kruskal-Wallis tests related PPA with mental health scores at each timepoint. Primary analyses did not identify significant differences in anxiety or depressive symptoms between exposure groups over time. Secondary analyses found CES-D scores across PPA categories were similar at 1-month (11, 10, 11, 11) and 6-months (10, 10, 11, 11) but differed at 3-months (9, 11, 10, 12; p = 0.035) and 12-months (10, 6, 11, 10; p = 0.019). GAD-7 scores did not vary across PPA categories at any time point. While abstinence was associated with fewer depressive symptoms at times, findings were not consistent during follow-up, perhaps reflecting intermittent relapse. PWH with polysubstance use and mental health comorbidity are complex, and larger samples with sustained abstinence would further elucidate effects of abstinence on mental health.

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Acknowledgements

Christina E. Freibott is supported by National Institute of Drug Abuse grant T32-DA041898-03. Natalie E. Chichetto is supported by National Institute on Alcohol Abuse and Alcoholism grant K01AA029042.

Funding

This work was supported by grants from the National Institute on Alcohol Abuse and Alcoholism (NI AAA) in support of URBAN ARCH: U01AA020780, U24AA020779, U24AA020778. Ms. Freibott and Ms. Biondi are supported by the National Institute of Drug Abuse (T32-DA041898).

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Authors and Affiliations

  1. Department of Health Law, Policy and Management, Boston University School of Public Health, 715 Albany Street Talbot Building, Boston, MA, 02118, USA

    Christina E. Freibott, Breanne E. Biondi & Michael D. Stein

  2. Department of Global Health, Boston University School of Public Health, Boston, MA, 02118, USA

    Sowmya R. Rao

  3. First Pavlov State Medical University of St. Petersburg, St. Petersburg, Russian Federation

    Elena Blokhina & Evgeny Krupitsky

  4. Biostatistics and Epidemiology Data Analytics Center (BEDAC), Boston University School of Public Health, Boston, MA, USA

    Julianne N. Dugas & Gregory Patts

  5. Department of Medicine, Section of General Internal Medicine, Clinical Addiction Research and Education (CARE) Unit, Boston Medical Center, Boston, MA, USA

    Sally Bendiks

  6. Department of Addictions, V.M. Bekhterev National Medical Research Center for Psychiatry and Neurology, St. Petersburg, Russian Federation

    Evgeny Krupitsky

  7. Department of Epidemiology, College of Public Health and Health Professions & College of Medicine, University of Florida, Gainesville, FL, 32611, USA

    Natalie E. Chichetto

  8. Department of Medicine, Section of General Internal Medicine, Clinical Addiction Research and Education (CARE) Unit, Boston University School of Medicine, Boston Medical Center, Boston, MA, USA

    Jeffrey H. Samet

  9. Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, USA

    Jeffrey H. Samet

  10. Vanderbilt Center for Clinical Cardiovascular Trials Evaluation (V-C3REATE), Cardiovascular Division, Vanderbilt University Medical Center, Nashville, TN, USA

    Matthew S. Freiberg

  11. Vanderbilt Center for Tobacco, Addiction and Lifestyle (VITAL), Division of Internal Medicine & Public Health and Vanderbilt Ingram Cancer Center (VICC), Vanderbilt University Medical Center, Nashville, TN, USA

    Hilary A. Tindle

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  1. Christina E. Freibott
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  2. Breanne E. Biondi
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Contributions

Christina E. Freibott: conceptualization, writing – original draft; Breanne E. Biondi: review & editing; Sowmya R. Rao: methodology, review & editing; Elena Blokhina: review & editing; Julianne N. Dugas: software, formal analysis, review & editing; Gregory Patts: methodology, review & editing; Sally Bendiks: project administration, review & editing; Evgeny Krupitsky: review & editing; Natalie E. Chichetto: review & editing; Jeffrey H Samet: review & editing, funding acquisition; Matthew S. Freiberg: review & editing, funding acquisition; Michael D. Stein: review & editing, supervision. Hilary Tindle: conceptualization, writing, review & editing, funding acquisition, supervision.

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Correspondence to Christina E. Freibott.

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The authors have no conflicts of interest to disclose.

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The St PETER study was approved by the Institutional Review Boards of Boston University Medical Campus, Vanderbilt University Medical Center, and Pavlov University.

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Informed consent was obtained from all participants included in the study.

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Freibott, C.E., Biondi, B.E., Rao, S.R. et al. Is Abstinence from Alcohol and Smoking Associated with Less Anxiety and Depressive Symptoms Among People with HIV?. AIDS Behav 28, 1447–1455 (2024). https://doi.org/10.1007/s10461-023-04231-9

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