Factors Associated with Smoking in HIV-Infected Patients and Potential Barriers to Cessation

Abstract

Smoking is common in patients with HIV and is associated with increased morbidity and mortality. With the goal of targeting future cessation interventions, we sought to identify factors associated with smoking status, readiness and confidence in cessation, and success in quitting. As part of a larger study in New York City assessing predictors of chronic obstructive pulmonary disease (COPD), we enrolled HIV-infected subjects at least 35 years of age without known asthma or COPD. Current smokers received detailed tobacco history, and smoking status was assessed by chart review at 3 and 6 months post-enrollment. Two hundred subjects were enrolled (29% current smokers, 31.5% never smokers, 39.5% former smokers, mean age of 49, 84% male, 64% had AIDS, and 97% were receiving antiretroviral therapy). Current smokers had higher unemployment and increased rates of other substance use than former smokers or never smokers. In multivariate analysis, being unemployed and having used inhalant drugs were associated with current smoking. Substance abuse history was not correlated with readiness to quit or patient estimated cessation. Lower education was associated with decreased readiness to quit. Follow-up smoking status for baseline current smokers was available for 47/58 enrollees at 6 months; 4 (9%) stopped smoking completely, and 17 (36%) decreased the number of packs-per-day. Smoking and concomitant substance abuse is common in HIV, and special attention should be given to this issue, in addition to a patient's readiness to quit, when implementing tobacco cessation protocols, especially in busy urban HIV care centers.

The Determinants of Poor Respiratory Health Status in Adults Living with Human Immunodeficiency Virus Infection

“…Moreover, these findings highlight the duty of physicians treating patients with HIV to address contributing risks for lung disease such as cigarette smoking. 50 …”

Screening for Chronic Obstructive Pulmonary Disease (COPD) in an Urban HIV Clinic: A Pilot Study

“…30 Evaluation included quantification of smoking exposure, marijuana and other illicit drug exposure, and a review of both HIV and opportunistic infection history. At the time of this study, ''undetectable'' viral load was defined at < 20 copies/mL, but the cutoff for undetectable varied when considering historical values in the chart.…”

“…[13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29] Patients with HIV/AIDS also have increased barriers to smoking cessation, which adds to the risk for COPD over time. 30 Prior pulmonary infection with Pneumocystis jiroveci or other pathogens may also influence lung function. 19,24 Studies show that in addition, HIV infected patients with higher HIV viral loads or lower CD4 T-cell counts have more rapid decline in pulmonary function, worse disease, and likely worse diffusing capacity than similar patients without HIV.…”

Cigarette Smokers are Less Likely to Have Undetectable Viral Loads

“…Current and former smokers were nearly twice as likely to have ever used marijuana, cocaine, amphetamine, or opiates and were three times as likely to have entered substance abuse treatment relative to never smokers. Recent studies with HIV populations have noted a similar association between smoking and substance use among PLHIV (Shirley et al, 2013) and suggest that HIV-infected smokers may represent a group of individuals with multiple addictions who are resistant to or unable to quit smoking and other drug use.…”

“…Since smoking is one of the biggest modifiable risk factors for cardiovascular and pulmonary diseases specifically in PLHIV, cessation strategies targeting this population are particularly relevant (Fiore et al, 2008; The Antiretroviral Therapy Cohort Collaboration, 2008). PLHIV smokers face unique barriers to smoking cessation, such as high rates of comorbid drug and alcohol use and mental illness (Bing et al, 2001), unemployment and lower socioeconomic status, lower quality of life (Shirley et al, 2013), inadequate social support (Gostin & Weber, 1998), and reliance on cigarettes as a coping mechanism for the stress associated with their illness (Helleberg et al, 2013). The Guidelines for Treating Tobacco Use and Dependence (Fiore et al, 2008) noted that studies examining smoking cessation interventions among HIV-infected patients are limited and generally show low rates of smoking cessation (Cummins et al, 2005; Fingeret et al, 2007; Ingersoll et al, 2009; Lloyd-Richardson et al, 2009; Vidrine et al, 2006), although more recent studies have shown cessation rates in this population ranging from 15% to 29% at 3 month follow-ups (Humfleet et al, 2013; Gritz et al, 2013).…”