Tobacco smoking and binge alcohol use are associated with incident venous thromboembolism in an HIV cohort

Brandon Luu, Stephanie Ruderman*, Robin Nance, Joseph A.C. Delaney, Jimmy Ma, Andrew Hahn, Susan R. Heckbert, Matthew J. Budoff, Kristina Crothers, William C. Mathews, Katerina Christopolous, Peter W. Hunt, Joseph Eron, Richard Moore, Jeanne Keruly, William B. Lober, Greer A. Burkholder, Amanda Willig, Geetanjali Chander, Mary E. McCaulKaren Cropsey, Conall O'Cleirigh, Inga Peter, Matthew Feinstein, Judith I. Tsui, Sara Lindstroem, Michael Saag, Mari M. Kitahata, Heidi M. Crane, Lydia N. Drumright, Bridget M. Whitney

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


Background: People with HIV (PWH) are at increased risk of cardiovascular comorbidities and substance use is a potential predisposing factor. We evaluated associations of tobacco smoking and alcohol use with venous thromboembolism (VTE) in PWH. Methods: We assessed incident, centrally adjudicated VTE among 12 957 PWH within the Centers for AIDS Research Network of Integrated Clinical Systems (CNICS) cohort between January 2009 and December 2018. Using separate Cox proportional hazards models, we evaluated associations of time-updated alcohol and cigarette use with VTE, adjusting for demographic and clinical characteristics. Smoking was evaluated as pack-years and never, former, or current use with current cigarettes per day. Alcohol use was parameterized using categorical and continuous alcohol use score, frequency of use, and binge frequency. Results: During a median of 3.6 years of follow-up, 213 PWH developed a VTE. One-third of PWH reported binge drinking and 40% reported currently smoking. In adjusted analyses, risk of VTE was increased among both current (HR: 1.44, 95% CI: 1.02–2.03) and former (HR: 1.44, 95% CI: 0.99–2.07) smokers compared to PWH who never smoked. Additionally, total pack-years among ever-smokers (HR: 1.10 per 5 pack-years; 95% CI: 1.03–1.18) was associated with incident VTE in a dose-dependent manner. Frequency of binge drinking was associated with incident VTE (HR: 1.30 per 7 days/month, 95% CI: 1.11–1.52); however, alcohol use frequency was not. Severity of alcohol use was not significantly associated with VTE. Conclusions: Current smoking and pack-year smoking history were dose-dependently associated with incident VTE among PWH in CNICS. Binge drinking was also associated with VTE. Interventions for smoking and binge drinking may decrease VTE risk among PWH.

Original languageEnglish (US)
Pages (from-to)1051-1060
Number of pages10
JournalHIV Medicine
Issue number10
StatePublished - Nov 2022


  • HIV
  • binge drinking
  • smoking
  • substance use
  • venous thromboembolism

ASJC Scopus subject areas

  • Infectious Diseases
  • Pharmacology (medical)
  • Health Policy


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