Consider the Substantial Adverse Effects
There are many adverse health effects of combining smoking with an HIV/AIDS diagnosis. Since the use of antiretroviral drugs became widespread, people with HIV/AIDS have been living much longer lives, making it critical to understand how health behaviors such as smoking and physical activity influence long-term health and quality of life. People living with HIV/AIDS who are smokers are:
More likely to be non-adherent to medication.
At higher risk for many AIDS-defining conditions.
At higher risk of premature death.
Report lower quality of life than non-smoking HIV/AIDS patients.
Smokers who live with HIV/AIDS also have a higher risk of opportunistic infections and other diseases than smokers without HIV/AIDS.
“The time is now for clinicians, tobacco control professionals, and researchers to work together and increase the focus on finding effective cessation strategies for people with HIV/AIDS and disseminating strategies that work.”
Research Lacking on Interventions
In an effort to understand what works in getting HIV/AIDS patients to quit smoking, I worked with a research assistant to examine the literature on smoking and cessation for people living with HIV/AIDS. Published in the July 2010 American Journal of Public Health, I found that the vast majority of the research looked only at the relationship between smoking and HIV/AIDS, but less than 2% of the articles examined the effectiveness of interventions aimed at preventing or reducing smoking among those living with HIV/AIDS. The accumulation of nearly 2 decades of discovery research leaves little doubt that smoking is a widespread problem and a major modifiable risk factor for disease and death in people living with HIV/AIDS. Unfortunately, we do not yet know the best strategy to help these patients quit. Typically, specialized smoking cessation programs that target certain populations can be effective. However, one study found that a standard smoking cessation program would not help 86% of smokers who have HIV/AIDS.
More Efforts Needed
The time is now for clinicians, tobacco control professionals, and researchers to work together and increase the focus on finding effective cessation strategies for people with HIV/AIDS and disseminating strategies that work. The delay between the discovery of smoking-related health outcomes in people living with HIV/AIDS and the delivery of interventions to reduce smoking among this population has serious consequences. To speed the process of finding solutions, researchers and clinicians in the HIV/AIDS field might collaborate with experts in tobacco cessation to find evidence-based programs and strategies for tailoring these programs and might partner with researchers to evaluate these programs and disseminate evidence about effective strategies. As the evidence builds, the burden on the clinician to identify a cessation strategy that is feasible and effective for the clinician’s practice will be reduced. Most importantly, in identifying and disseminating effective cessation strategies for people with HIV/AIDS we could improve health outcomes and quality of life.
Readings & Resources (click to view)
Harris JK. Connecting discovery and delivery: the need for more evidence on effective smoking cessation strategies for people living with HIV/AIDS. Am J Public Health. 2010;100:1245-1249. Abstract available at:http://ajph.aphapublications.org/cgi/content/abstract/AJPH.2009.172460v1
Drach L, Holbert T, Maher J, Fox V, Schubert S, Saddler LC. Integrating smoking cessation into HIV care. AIDS Patient Care STDS. 2010;24:139-140.
Zwiebel MA, Hughes V. Smoking cessation efforts in one New York city HIV clinic. J Assoc Nurses AIDS Care. 2010;21:11-15.
Goldberg D, Weber KM, Orsi J, et al. Smoking cessation among women with and at risk for HIV: are they quitting? J Gen Intern Med. 2010;25:39-44.