Effectiveness of Varenicline and Cytisine for Alcohol Use Reduction Among People With HIV and Substance Use

Tindle, Hilary A.; Freiberg, Matthew S.; Cheng, Debbie M.; Gnatienko, Natalia; Blokhina, Elena; Yaroslavtseva, T. V.; Bendiks, Sally; Patts, Gregory; Hahn, Judith; So‐Armah, Kaku; Stein, Michael D.; Bryant, Kendall; Lioznov, Dmitry; Krupitsky, Evgeny; Samet, Jeffrey H.

doi:10.1001/jamanetworkopen.2022.25129

Cited by 14 publications

(12 citation statements)

References 58 publications

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“…Two trials [14,21] compared the efficacy of cytisine versus NRT with dissimilar results. The combination of both studies yields modest results in favor of cytisine (RR of 1.39 (95% CI = 1.12-1.73); participants = 1511; I 2 = 0%).…”

Section: Summary Of Main Resultsmentioning

confidence: 99%

“…Combining the findings of the two RCTs [14,21], which compared the efficacy of cytisine versus NRT involving 1511 participants, 755 took cytisine, delivering a RR of 1.39 (95% CI = 1.12-1.73), with a low level of heterogeneity (I 2 = 0%); Figure 9…”

Section: Cytisine Versus Nrtmentioning

confidence: 99%

“…Three trials [16,18,21], compared the efficacy of cytisine versus varenicline involving 2331 participants, 1162 of whom took cytisine. Pooling these data demonstrated a clear benefit for cytisine compared to varenicline with an RR of 1.17 (95% CI = 0.78-1.77), with moderate to substantial heterogeneity (I 2 = 60%).…”

Section: Cytisine Versus Vareniclinementioning

confidence: 99%

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Evaluation of the effectiveness of cytisine for the treatment of smoking cessation: A systematic review and meta‐analysis

De Santi,

Orellana,

Di Niro

et al. 2023

Addiction

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Background and aimsSmoking is considered the main cause of preventable death world‐wide. This study aimed to review the efficacy and safety of cytisine for smoking cessation.MethodsThis review included an exhaustive search of databases to identify randomized controlled trials (RCTs) in health centers of any level with smokers of any age or gender investigating the effects of cytisine at standard dosage versus placebo, varenicline or nicotine replacement therapy (NRT).ResultsWe identified 12 RCTs. Eight RCTs compared cytisine with placebo at the standard dose covering 5922 patients, 2996 of whom took cytisine, delivering a risk ratio (RR) of 2.25 [95% confidence interval (CI) = 1.42–3.56; I2 = 88%; moderate‐quality evidence]. The greater intensity of behavioral therapy was associated directly with the efficacy findings (moderate‐quality evidence). The confirmed efficacy of cytisine was not evidenced in trials conducted in low‐ and middle‐income countries. We estimate a number needed to treat (NNT) of 11. Two trials compared the efficacy of cytisine versus NRT, and the combination of both studies yields modest results in favor of cytisine. Three trials compared cytisine with varenicline, without a clear benefit for cytisine. Meta‐analyses of all non‐serious adverse events in the cytisine group versus placebo groups yielded a RR of 1.24 (95% CI = 1.11–1.39; participants = 5895; studies = 8; I2 = 0%; high‐quality evidence).ConclusionsCytisine increases the chances of successful smoking cessation by more than twofold compared with placebo and has a benign safety profile, with no evidence of serious safety concerns. Limited evidence suggests that cytisine may be more effective than nicotine replacement therapy, with modest cessation rates.

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Section: Summary Of Main Resultsmentioning

confidence: 99%

Section: Cytisine Versus Nrtmentioning

confidence: 99%

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Evaluation of the effectiveness of cytisine for the treatment of smoking cessation: A systematic review and meta‐analysis

De Santi,

Orellana,

Di Niro

et al. 2023

Addiction

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“…9,39 However, recent studies demonstrate that pharmacotherapy can result in smoking cessation even among high-risk PWH who have multimorbidity and polysubstance use. 40–42 In contrast, Black patients and those with diabetes had a lower risk of incident AAA in the VACS. Although the factors underlying these associations are not clear, lower rates and risk of AAA in the Black community 38 as well as in individuals with diabetes 43 is a well-described phenomenon in the general population.…”

Section: Discussionmentioning

confidence: 95%

Association of HIV Infection and Incident Abdominal Aortic Aneurysm Among 143 001 Veterans

Filipkowski,

Kundu,

Eden

et al. 2023

Circulation

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BACKGROUND: People with HIV (PWH) have an increased risk of cardiovascular disease. Previous cross-sectional data suggest there is a higher prevalence of abdominal aortic aneurysm (AAA) in PWH than in those without HIV. Whether PWH have an increased risk of incident AAA compared with those without HIV is unknown. METHODS: We analyzed data among participants without prevalent AAA from the Veterans Aging Cohort Study, a prospective, observational, longitudinal cohort of veterans with HIV matched 1:2 with veterans without HIV infection. We calculated AAA rates by HIV status and assessed the association between HIV infection and incident AAA using Cox proportional hazards models. We defined AAA using the International Classification of Diseases, 9th or 10th revision, or Current Procedural Terminology codes and adjusted all models for demographic characteristics, cardiovascular disease risk factors, and substance use. Secondary analyses examined the association between time-varying CD4+ T-cell count or HIV viral load and incident AAA. RESULTS: Among 143 001 participants (43 766 with HIV), over a median follow-up of 8.7 years, there were 2431 incident AAA events (26.4% among PWH). Rates of incident AAA per 1000 person-years were similar among PWH (2.0 [95% CI, 1.9–2.2]) and people without HIV (2.2 [95% CI, 2.1–2.3]). There was no evidence that HIV infection increased the risk of incident AAA compared with no HIV infection (adjusted hazard ratio, 1.02 [95% CI, 0.92–1.13]). In adjusted analyses with time-varying CD4+ T-cell counts or HIV viral load, PWH with CD4+ T-cell counts <200 cells/mm 3 (adjusted hazard ratio, 1.29 [95% CI, 1.02–1.65]) or HIV viral load ≥500 copies/mL (adjusted hazard ratio, 1.29 [95% CI, 1.09–1.52]) had an increased risk of AAA compared with those without HIV. CONCLUSIONS: HIV infection is associated with an increased risk of AAA among those with low CD4+ T-cell counts or elevated HIV viral load over time.

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“…Second, St PETER HIV, a clinical trial comparing the effects of varenicline, cytisine, and nicotine replacement therapy for alcohol and tobacco use reduction, enrolled 400 participants with HIV from 2017 to 2019 and followed them for 12 months. 25 Eligibility for St PETER HIV did not include ART status but did include age 18–70 years, report of ≥5 heavy drinking days (HDD) in the past 30 days, smoking an average of ≥5 cigarettes per day, interest in reducing alcohol or tobacco use, and a stable address within 100 km of St. Petersburg. Exclusion criteria included pregnancy or breastfeeding, certain comorbidities (eg, seizures and unstable psychiatric illness), and recent use of smoking cessation therapy.…”

Section: Methodsmentioning

confidence: 99%

Association of Alcohol Consumption With CD4 Recovery After Antiretroviral Therapy Initiation in St. Petersburg, Russia

McLaughlin,

Lin,

Jiang

et al. 2023

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Background: Delayed CD4 recovery after initiating antiretroviral therapy (ART) is a novel potential mechanism by which alcohol consumption leads to increased morbidity and mortality in people with HIV. We hypothesized that alcohol consumption at ART initiation is associated with slower CD4 recovery. Methods: We retrospectively analyzed 2 pooled longitudinal alcohol/HIV cohorts (2014–2019) in St. Petersburg, Russia. Eligible participants initiated the first ART during parent studies; had alcohol consumption assessed by the blood biomarker, phosphatidylethanol (PEth), at the last research visit before ART initiation; and had ≥1 CD4 count measurement before and after initiating ART. Participants were stratified by low, moderate, and high PEth (<8, 8–80, and >80 ng/mL, respectively). We used random-effects piecewise linear regression models to estimate CD4 recovery, defined as CD4 count change per 30 days after ART initiation, by the alcohol group. Results: Of 60 eligible participants, median age was 34 years and 28% were female. The median pre-ART PEth in the low, moderate, and high PEth groups were <8, 23, and 232 ng/mL, respectively. After starting ART, the CD4 count increased by 13.60 cells/mm3/mo (95% CI: 0.33 to 26.87) with low PEth, 0.93 cells/mm3/mo (95% CI: −6.18 to 8.04) with moderate PEth, and 2.33 cells/mm3/mo (95% CI: −3.44 to 8.09) with high PEth. Conclusions: Among Russians with HIV, we observed faster CD4 recovery after ART initiation in those with low alcohol consumption compared with those with moderate and high alcohol consumption, as assessed by PEth. This analysis provides further evidence for the possible value of alcohol reduction interventions for people with HIV who are initiating ART.

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Effectiveness of Varenicline and Cytisine for Alcohol Use Reduction Among People With HIV and Substance Use

Abstract: This randomized clinical trial compares the effectiveness of varenicline and cytisine with nicotine replacement therapy for reducing alcohol consumption among individuals with HIV who smoke daily and engage in risky drinking.

Cited by 14 publications

References 58 publications

Evaluation of the effectiveness of cytisine for the treatment of smoking cessation: A systematic review and meta‐analysis

Evaluation of the effectiveness of cytisine for the treatment of smoking cessation: A systematic review and meta‐analysis

Association of HIV Infection and Incident Abdominal Aortic Aneurysm Among 143 001 Veterans

Association of Alcohol Consumption With CD4 Recovery After Antiretroviral Therapy Initiation in St. Petersburg, Russia

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