NOT-DA-21-017 Notice of Special Interest (NOSI): Medical Consequences of Smoking and Vaping Drugs of Abuse in Individuals with HIV and COVID-19

Background: Tobacco use, particularly cigarette smoking, is a leading lifestyle-related cause of death in the United States. HIV-positive individuals who smoke experience higher morbidity and mortality compared to HIV-positive nonsmokers. Smoking is significantly associated with a greater risk for cardiovascular disease and non-AIDS malignancies, including non-AIDS-related cancers. Among HIV-positive people on antiretroviral therapy, HIV-positive smokers have a two-fold increase in mortality, compared to HIV-positive nonsmokers. Vaping is becoming highly prevalent, particularly among teenagers and young adults. Teenagers and young adults who vaped were 5-7 times more likely to be infected with SARS-CoV2 than those who did not use e-cigarettes.

COVID-19 can severely affect cardiovascular, respiratory, renal, gastrointestinal, hematological, immunological, and central (CNS) and peripheral nervous systems (PNS) with long-term consequences yet to be fully known or understood. Hypercoagulability, cardiomyopathy, pneumonia, inflammatory lympho-/chemokine storm, diarrhea, renal failure, Guillain-Barre syndrome, transverse myelitis, psychosis and coma have been caused by SARS-CoV2.

People living with HIV are recognized as being at potentially greater risk for severe COVID-19 by the CDC though data are still scant. Thus, it is of public health relevance to understand the potential deleterious effects of smoking and vaping in among individuals with HIV who had been infected with the SARS-CoV2. Thanks to significant investments in electronic health records (EHR) over the past years and the establishment of large databases, data mining strategies can be employed to facilitate research into the smoking and vaping/COVID 19/HIV syndemic.

Rationale: In the midst of the COVID-19 pandemic, HIV clinical research and medical care have been negatively impacted. “Stay-at-home” recommendations, solitude, unemployment, lack of medical resources, distress, and sickness have all raised the level of anxiety, with consequent reinforcement of addictive behaviors, like smoking or vaping tobacco, marijuana, cocaine, and/or methamphetamine. The long-term effects of COVID-19 disease are not known. Recent studies suggest possible pathogenic roles between nicotine and angiotensin-2 receptors, investigations which are critical for understanding the pathogenesis of COVID-19. Thus, it is scientifically justified to study whether and how smoking and/or vaping addictive substances impact on the morbidity and mortality of people with HIV and SARS-CoV2 co-infection. Large COVID-19 datasets already exist to facilitate this research.

Research Objectives: NIDA is interested in receiving research applications focusing on individuals with HIV who smoke or vape marijuana, tobacco, cocaine and/or methamphetamine to determine the long-term effects of their use among individuals with HIV and COVID-19.

Research Areas:

  • The risks that smoking and/or vaping tobacco, marijuana, cocaine, and/or methamphetamine may have on acquiring the SARS-CoV2 infection in individuals with HIV.
  • The medical consequences, co-morbidity, and complications of SARS-CoV2 infection affecting cardiovascular, respiratory, renal, gastrointestinal, hematological, immunological, CNS and PNS systems in HIV individuals who smoke and/or vape tobacco, marijuana, cocaine, and/or methamphetamine.
  • Defining mechanisms by which substance use and HIV interact to increase susceptibility to severe COVID-19 affecting cardiovascular, respiratory, renal, gastrointestinal, hematological, immunological, CNS and PNS morbidity.
  • Utilization of large database- Electronic Health Records – strategies for retrospective and platform based prospective studies, cross analyses, and real-time health delivery and critical health-related decisions in emergency medicine settings.

Investigators are encouraged to make use of existing data sets and resources