Cigarette smoking remains substantially more common among people with HIV (PWH) than in the general population, with prevalence estimates approximately two- to threefold higher. Smoking contributes importantly to cardiovascular risk in PWH; specifically, cigarette use increases the risk of myocardial infarction (MI) in this population. Prior research in non-HIV populations has associated faster nicotine metabolism—measured by the nicotine metabolite ratio (NMR)—with greater likelihood of nicotine dependence and higher lung cancer risk. Whether faster nicotine metabolism as quantified by NMR is associated with incident MI among PWH who smoke had not been established prior to this study.
The investigators conducted a nested case-control study within the Center for AIDS Research Network of Integrated Clinical Systems (CNICS) cohort. Eligibility for inclusion in the nested study required being a person with HIV who reported cigarette use and having available plasma samples for measurement.
Cases were defined as PWH who reported cigarette use and experienced an incident, adjudicated myocardial infarction between 2003 and 2020 and for whom plasma was available. Controls were selected using incidence density sampling from the pool of cigarette-smoking PWH who had not experienced MI at the case index date. Controls were matched to cases on age, race, birth sex, and plasma HIV RNA level to reduce confounding by these factors.
The primary exposure of interest was the nicotine metabolite ratio (NMR) measured in plasma. The study planned to estimate the association between NMR and MI using conditional logistic regression appropriate for matched case-control data. Odds ratios (ORs) and corresponding confidence intervals were to be used to quantify the relationship between NMR and risk of adjudicated MI.
The abstract indicates the investigators identified 135 cases meeting the case definition. Conditional logistic regression was specified to estimate ORs for the association of NMR and MI, leveraging the matched design. Matching variables included age, race, birth sex, and plasma HIV RNA level; this matching strategy aimed to control for these potential confounders at the design stage.
Additional analytic details that would typically be reported—such as categorization of NMR (continuous versus categorical), covariates included beyond the matched factors, handling of missing data, and planned sensitivity analyses—are not included in the provided source text.
The publicly available portion of the source text is truncated after reporting identification of 135 cases. The abstract and visible content do not report the following essential outcome data:
Because these results are not present in the provided text, no effect estimates or statistical conclusions can be stated here. Readers seeking the complete results and numerical findings should consult the full manuscript (PLoS One, 2026) or the journal’s online record using the DOI 10.1371/journal.pone.0356296 or PMID 42611874.
The source text available to this summary does not include the authors’ conclusions or discussion of clinical implications. Specifically, the following items are not reported in the supplied excerpt:
Until the full results and authors’ interpretations are reviewed, clinical implications cannot be inferred from the truncated abstract alone.
This work was published in PLoS One in 2026 (eCollection 2026). The PubMed identifier (PMID) is 42611874 and the DOI is 10.1371/journal.pone.0356296. The author list includes researchers affiliated with multiple institutions in the United States and Canada, including the University of Pennsylvania, University of Toronto, University of Pittsburgh, University of Florida, University of California San Francisco, Georgetown Medical Center, Case Western Reserve University, UC San Diego, University of North Carolina at Chapel Hill, and SUNY Buffalo.
For readers who need the complete numeric results, adjusted estimates, and authors’ discussion, access to the full text via the journal (PLoS One) or PubMed central links is required. The excerpt used for this summary is incomplete and does not permit reporting of the study’s primary outcome results or conclusions.