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Ten Things Every HIV Clinician Should Know About Smoking

Spring 2016

  1. In HIV-positive North Americans and Europeans, smoking decreases survival more than HIV itself.1
  2. Analysis of 18,000 HIV-positive people in Europe and North American determined that smokers have a twice higher death rate than nonsmokers. But former HIV-positive smokers and neversmokers have equivalent death rates.1
  3. In a study of 2000 US veterans, all-cause mortality was more than 80% higher in in HIV-positive smokers than HIV-positive never-smokers whether they smoked under 20 pack-years* or over 20 pack-years.2
  4. A nationwide study in Denmark found that HIV-positive smokers run a 6 times higher risk of myocardial infarction than HIV-positive people who never smoked.3
  5. Compared with HIV-negative smokers in the United States, HIV-positive smokers who had AIDS pneumonia run a 3.5-fold higher risk of lung cancer.4
  6. A large proportion of US smokers manage to quit. In fact, the United States has more ex-smokers than current smokers.5
  7. US clinicians don't do as well getting HIV-positive smokers to quit as they do with HIV-negative smokers. The CDC figures a quit ratio of 52% in the general population, compared with 32% in people with HIV.6
  8. Fewer than half of US HIV clinicians frequently prescribe any of the three medications recommended for smoking cessation: nicotine replacement, varenicline (Chantix), or bupropion (Zyban).7
  9. Studies in people with HIV show that quit rates can reach as high as 1 in 5 to 2 in 5 with varenicline,8 bupropion,9 or nicotine replacement.10
  10. SMART trial analysis of people with HIV determined that current smokers had a higher risk of five outcomes than people who had quit smoking: all-cause mortality, AIDS-related disease, major cardiovascular disease, non-AIDS cancer, and bacterial pneumonia.11

* A pack-year measures the number of packs smoked daily for life. Twenty pack-years could mean smoking 1 pack daily for 20 years or smoking 2 packs daily for 10 years.

† Quit ratio = former smokers/(former + current smokers).


References

  1. Helleberg M, May MT, Ingle SM, et al. Smoking and life expectancy among HIV-infected individuals on antiretroviral therapy in Europe and North America. AIDS. 2015;29:221-229.
  2. Crothers K, Goulet JL, Rodriguez-Barradas MC, et al. Impact of cigarette smoking on mortality in HIV-positive and HIV-negative veterans. AIDS Educ Prev. 2009;21(3 suppl):40-53.
  3. Rasmussen LD, Helleberg M, May MT, et al. Myocardial infarction among Danish HIV-infected individuals: population-attributable fractions associated with smoking. Clin Infect Dis. 2015;60:1415-1423.
  4. Hessol NA, Martinez-Maza O, Levine AM, et al. Lung cancer incidence and survival among HIV-infected and uninfected women and men. AIDS. 2015;29:1183-1193.
  5. The Health Consequences of Smoking -- 50 Years of Progress: A Report of the Surgeon General. US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2014.
  6. Mdodo R, Frazier EL, Dube SR, et al. Cigarette smoking prevalence among adults with HIV compared with the general adult population in the United States. Ann Intern Med. 2015;162:335-344.
  7. Shuter J, Salmo LN, Shuter AD, Nivasch EC, Fazzari M, Moadel AB. Provider beliefs and practices relating to tobacco use in patients living with HIV/AIDS: a national survey. AIDS Behav. 2012;16:288-294.
  8. Mercié P, Roussillon C, Katlama C, et al. Varenicline vs placebo for smoking cessation: ANRS 144 Inter-ACTIV randomized trial. CROI 2015. February 23-26, 2015. Seattle, Washington. Abstract 139.
  9. Pedrol-Clotet E, Deig-Comerma E, Ribell-Bachs M, Vidal-Castell I, García-Rodríguez P, Soler A. Bupropion use for smoking cessation in HIV-infected patients receiving antiretroviral therapy. Enferm Infecc Microbiol Clin. 2006;24:509-511.
  10. Shuter J, Morales DA, Considine-Dunn SE, An LC, Stanton CA. Feasibility and preliminary efficacy of a web-based smoking cessation intervention for HIV-infected smokers: a randomized controlled trial. J Acquir Immune Defic Syndr. 2014;67:59-66.
  11. Lifson AR, Neuhaus J, Arribas JR, et al. Smoking-related health risks among persons with HIV in the Strategies for Management of Antiretroviral Therapy Clinical Trial. Am J Public Health. 2010;100:1896-1903.


Related Stories

Smoking Accounts for More Heart Attacks in People With Than Without HIV
HIV-Positive Individuals on Treatment Lose More Years of Life to Smoking Than to HIV
Varenicline (Chantix) Helps HIV-Positive Individuals Quit Smoking but Overall Success Rates Low



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