Clearing the smoke around the TB-HIV syndemic: smoking as a critical issue for TB and HIV treatment and care

Abstract

SUMMARY The collision of the tuberculosis (TB) and human immunodeficiency virus (HIV) epidemics has been described as a ‘syndemic’ due to the synergistic impact on the burden of both diseases. This paper explains the urgent need for practitioners and policy makers to address a third epidemic that exacerbates TB, HIV and TB-HIV. Tobacco use is the leading cause of preventable death worldwide. Smoking is more prevalent among persons diagnosed with TB or HIV. Smoking is associated with tuberculous infection, TB disease and poorer anti-tuberculosis treatment outcomes. It is also associated with an increased risk of smoking-related diseases among people living with HIV, and smoking may also inhibit the effectiveness of life-saving ART. In this paper, we propose integrating into TB and HIV programmes evidence-based strategies from the ‘MPO-WER’ package recommended by the World Health Organization’s Framework Convention on Tobacco Control. Specific actions that can be readily incorporated into current practice are recommended to improve TB and HIV outcomes and care, and reduce the unnecessary burden of death and disease due to smoking.

The prevalence and associated factors for delayed presentation for HIV care among tuberculosis/HIV co-infected patients in Southwest Ethiopia: a retrospective observational cohort

“…For the above reasons, Tb experts declare “Clearing the smoke around the Tb/HIV Syndemic” [50]. In addition, the current finding may also call for designing and including strategies in the routine program to reduce tobacco among Tb/HIV co-infected patients [51].…”

“…In support of this, The Center for Disease Control (CDC) also calls for prompt action to incorporate anti-smoking strategies into Tb, HIV, and Tb-HIV care, and advise to apply the World Health Organization’s MPOWER [52] strategy for lessening tobacco use [51]. This is critical issue for Tb and HIV treatment and care in contributing not only for earlier presentation for HIV care but also for developing good prognosis after linking the care [50]. However, we also advised further study to explore the association between smoking and time to present for HIV care among the population.…”

“…These findings do not come as a surprise because patients who are bedridden have probably been exposed to more infections and have poorer health outcomes, a barrier that hinders early presentation for HIV care [50, 53]. It is thus plausible to suggest routine opportunistic infections and other diseases screening in patients with Tb or HIV in order to establish early and effective management strategies to reduce preventable mortalities from these conditions.…”

Tobacco Smoking and Tuberculosis among Men Living with HIV in Johannesburg, South Africa: A Case-Control Study

“…We likely underestimated smoking prevalence in our study, as patients with TB in South Africa may have stopped smoking at symptom onset or as symptoms worsened and been classified as former smokers [18,20]. Given the frequent interactions with the health system required by patients living with HIV and TB, these men represent a key population where practitioners and programs can implement tobacco control interventions to reduce tobacco-related morbidity and mortality and improve TB and HIV therapeutic outcomes [8]. …”

“…The HIV epidemic in South Africa is the largest in the world and includes 6.5 million adults living with HIV [6]. Among adults living with HIV, there is evidence that the prevalence of smoking is higher than that among adults not infected with HIV [7,8]. Additionally, patients with suspected and confirmed TB in South Africa have a higher prevalence of smoking compared to the one-third reported among the general population [5,9,10].…”