Reversing High Smoking Rates in People with HIV

In the US, the prevalence of smoking among people with HIV is roughly three times that of the general population. That puts these patients at risk of developing co-morbidities. It may even directly interfere with the workings of antiretroviral drugs. The question for clinicians is how to help them quit.

Researchers in Texas and New York, writing in HIV/AIDS - Research and Palliative Care found that a combination of behavioral and pharmacotherapy treatments are most beneficial to HIV patients who smoke.

Lead author, Kariuki Wanjiku, of the University of Texas School of Public Health, noted that there is ongoing debate about whether or not smoking lessens the effectiveness of highly active antiretroviral therapy (HAART).

Some studies show that smoking brings about “an inferior immune response and a higher probability of virologic rebound,” according to the researchers, while other others seem to conclude that smoking does not accelerate the disease progression, but does increase the risk of smoking-related chronic illnesses.

As in the general population, people with HIV who smoke have a greater risk of coronary heart disease, decreased cognitive function, decreased pulmonary function, and lower health-related quality of life. In addition, the authors say, “Although HIV-infected individuals with access to HAART are living longer, cigarette smoking habits still contribute to excess morbidity and mortality within this population.”

Behavioral interventions to promote smoking cessation often include various individual and group programs, as well as online and phone counseling. The researchers only identified two, small-scale studies that examined the effectiveness of behavioral interventions for HIV patients.

Pharmacotherapy for smoking cessation is usually combined with a behavioral program. Any of the available pharmacotherapeutic agents that are approved for smoking cessation can be used by HIV-positive patients. Patches, gum, nasal spray and other forms of nicotine replacement therapy (NRT) are the most effective pharmacotherapeutic agents for smoking cessation. No one form of NRT is better than the others, but all work better when two are used in combination.

Nicotine electronic cigarettes (e-cigarettes) are as effective as NRT, but there are some safety concerns. Quality control and potentially toxic substances contained in the vapor are both areas of concern for scientists. Varenicline and bupropion are both approved by the FDA for use as smoking cessation products. They each have considerable side effects.

Most smoking cessation programs use a combined approach.

Among HIV-infected people, the most effective combination seems to be NRT and phone counseling.

This review found that “the strongest evidence supported the combined interventions that incorporated both behavioral and pharmacological approaches and used randomized controlled study designs,” according to the authors.

They recommend additional research to determine the relative contribution of each method, as well as to “increase the uptake of smoking cessation interventions in routine practice.”