Abstract
People with HIV (PWH) smoke cigarettes 2-3 times more and are 3 times more likely to have clinical depression relative to the general population. Physical activity (PA) can aid in smoking cessation and reduce depression in the general population; the role of PA for smoking cessation among PWH is unknown. Data collected between October 2021-September 2022 from the Multicenter AIDS Cohort Study (MACS)/Women Interagency HIV Study (WIHS) Combined Cohort Study (MWCCS) were analyzed using logistic regression and structural equation modeling to examine associations between cigarette smoking, PA and depression. Among adult PWH (n = 1584), 505 were insufficiently active (MET-min/week ≤ 500), 400 were currently smoking, and 420 had clinically significant depressive symptoms (CES-D ≥ 16). The odds of current smoking were significantly higher among PWH who were insufficiently active compared to sufficiently active, even after adjusting for age, sex, body mass index, race, ethnicity, substance use, and viral load (aOR = 1.40 [95% CI: 1.04-1.87], p = 0.03). Similarly, the odds of current smoking were significantly higher among PWH with more symptoms of depression in adjusted models (aOR = 1.57 [95% CI: 1.16-2.12], p = 0.003). When stratified by sex, the odds of current smoking remained significantly higher among female PWH, but not male PWH who were insufficiently active. The odds of current smoking also remained significantly higher among females but not males with more symptoms of depression. Structural equation modeling indicated that PA and depression have independent and direct effects on smoking among PWH. Physical inactivity and depression are associated with smoking, but longitudinal studies are needed to better understand directionality and causality.