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Methods: This is a cross-sectional study of PWH with heavy drinking and daily smoking in St. Petersburg, Russia. The primary independent variable was past 30-day cigarettes per day (cpd), and the secondary independent variable was pack-years at study entry. Advanced liver fibrosis was defined as FIB-4 &gt; 3.25. Analyses were adjusted for gender, body mass index (BMI), past 30-day number of heavy drinking days, HCV and CD4 count. Results: Participants (n = 400) were two-thirds male (67.3%), young (median age 38 years), lean (median BMI 22), HCV antibody positive (84.5%) and not severely immune suppressed (median CD4 count 351). The median number of past-month cpd was 20 (IQR: 15\u201325), and the median pack-years was 24 (IQR: 17\u201331.8). The prevalence of advanced liver fibrosis was 11.3% (45\/400). In the adjusted logistic regression analyses, we did not observe a significant association between cpd [middle (10.1\u201320 cigarettes) vs. lowest (5\u201310 cigarettes) category (adjusted odds ratio [aOR] (95% confidence interval [CI]): 1.06 (0.40\u20132.83), highest (&gt;20.0 cigarettes) vs. lowest category aOR (95% CI): 0.65 (0.21\u20131.99), global p-value = 0.62]. The secondary analysis with pack-years yielded similar results [middle (20.1\u201330 pack-years) vs. lowest category (\u226420 pack-years) aOR (95% CI): 0.81 (0.33\u20131.99), highest category (&gt;30 pack-years) vs. lowest category aOR (95% CI): 0.91 (0.38\u20132.19); global p-value = 0.58]. Conclusions: In this Russian cohort of PWH, we did not detect an association between recent cigarette use or mean pack-years and advanced liver fibrosis.<\/jats:p>","DOI":"10.3390\/jcm14041169","type":"journal-article","created":{"date-parts":[[2025,2,11]],"date-time":"2025-02-11T05:34:32Z","timestamp":1739252072000},"page":"1169","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Is There an Association Between Cigarette Smoking and Advanced Liver Fibrosis in Smokers with HIV, Heavy Drinking and High Prevalence of HCV?"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1262-5860","authenticated-orcid":false,"given":"Daniel","family":"Fuster","sequence":"first","affiliation":[{"name":"Addiction Unit, Internal Medicine Department, Hospital Universitari Germans Trias i Pujol, Universitat Aut\u00f2noma de Barcelona, 08916 Badalona, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kaku","family":"So-Armah","sequence":"additional","affiliation":[{"name":"Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine\/Boston Medical Center, Boston, MA 02118, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Debbie M.","family":"Cheng","sequence":"additional","affiliation":[{"name":"Biostatistics Department, Boston University School of Public Health, Boston, MA 02118, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elena","family":"Blokhina","sequence":"additional","affiliation":[{"name":"Laboratory of Clinical Psychopharmacology of Addictions, First Pavlov State Medical University, 197022 St. Petersburg, Russia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gregory","family":"Patts","sequence":"additional","affiliation":[{"name":"Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, MA 02118, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3643-7354","authenticated-orcid":false,"given":"Dmitry","family":"Lioznov","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases and Epidemiology, First Pavlov State Medical University, 197022 St. Petersburg, Russia"},{"name":"Smorodintsev Research Institute of Influenza, 197022 St. Petersburg, Russia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Natalia","family":"Gnatienko","sequence":"additional","affiliation":[{"name":"Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center, Boston, MA 02118, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michelle T.","family":"Long","sequence":"additional","affiliation":[{"name":"Gastroenterology Section, Department of Medicine, Boston University School of Medicine\/Boston Medical Center, Boston, MA 02118, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matthew S.","family":"Freiberg","sequence":"additional","affiliation":[{"name":"Cardiovascular Medicine Division, Vanderbilt University Medical Center, Nashville, TN 37232, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hilary","family":"Tindle","sequence":"additional","affiliation":[{"name":"ViTAL, the Vanderbilt Center for Tobacco, Addiction and Lifestyle, Vanderbilt University Medical Center, Nashville, TN 37232, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jeffrey H.","family":"Samet","sequence":"additional","affiliation":[{"name":"Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine\/Boston Medical Center, Boston, MA 02118, USA"},{"name":"Department of Community Health Sciences, Boston University School of Public Health, Boston, MA 02118, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,2,11]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1198","DOI":"10.1016\/S0140-6736(10)62001-6","article-title":"Increasing burden of liver disease in patients with HIV infection","volume":"377","author":"Joshi","year":"2011","journal-title":"Lancet"},{"key":"ref_2","first-page":"101","article-title":"HIV and the Liver","volume":"27","author":"Sherman","year":"2019","journal-title":"Top. 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