(P-037) Vaporized Nicotine (E-cig) Use Among People with HIV in Care in the US

Background: Vaporized nicotine (VN) use, including e-cigarettes, is increasing among people with HIV (PWH). There are significant health concerns about VN and growing evidence against their efficacy as a tobacco cigarette (TC) cessation aid. Little has been published characterizing the epidemiology of VN use among PWH.

Objectives: We examined demographic characteristics, patterns of use, and mental health symptoms associated with VN use among PWH in primary HIV care.

Methods: We analyzed VN use among PWH in care at 7 sites across the US from 10/2017-3/2020. PWH completed a clinical assessment of patient reported outcomes, including substance use and mental health symptoms, as part of routine care. Dichotomized depression and anxiety symptoms were assessed using the PHQ-9 and the HIV symptom index. We categorized VN and TC as never, former, or current use and used generalized linear models with a Poisson distribution and log link to examine associations between VN use and depression or anxiety. We evaluated associations between pairs of VN use categories, and each model was adjusted for age, sex, race/ethnicity, HIV transmission risk factor, and current use of TC.

Results: Among 5,412 PWH (83% male, 46% White/36% Black, mean age 48 yrs), 272 (5%) reported current VN use and 771 (14%) reported former VN use. Current VN use was almost exclusively (95%) among PWH who reported former or current TC use; however, 254 (8%) PWH who reported ever using TC reported current VN use. PWH reporting current VN use were more likely than those who reported no use or former use to be younger, White, and to report injection drug use as an HIV risk factor.
Among current VN users, 60% reported daily use. Compared to PWH who reported never using VN, depression was more common among those who reported either current (Relative Risk: 1.40 [95%CI: 1.08-1.81]) or former (1.30 [1.12-1.49]) VN use. Likewise, anxiety was more common among PWH who reported current (1.57 [1.23-2.01]) or former (1.35 [1.18-1.54]) VN use compared to those who never used. However, PWH reporting current VN use were not more likely to report depression (1.07 [0.85-1.36]) or anxiety (1.09 [0.88-1.36]) than PWH with former VN use.

Conclusions: PWH more often reported former than current VN use and VN use was almost exclusively reported among people reporting TC use. Our findings, even after accounting for TC use among current and former VN users, suggest that VN use may be a coping strategy adopted by PWH experiencing anxiety and depression symptoms, but warrants longitudinal and qualitative data to confirm. These findings may facilitate targeted interventions to support healthier symptom management strategies and more efficacious tobacco cessation approaches among PWH.