Interventions to Address Chronic Disease and HIV: Strategies to Promote Smoking Cessation Among HIV-infected Individuals
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BEHAVIORAL ASPECTS OF HIV MANAGEMENT (RJ DICLEMENTE AND JL BROWN, SECTION EDITORS)
Interventions to Address Chronic Disease and HIV: Strategies to Promote Smoking Cessation Among HIV-infected Individuals Raymond Niaura & Geetanjali Chander & Heidi Hutton & Cassandra Stanton
Published online: 13 September 2012 # Springer Science+Business Media, LLC 2012
Abstract Tobacco use, especially cigarette smoking, is higher than average in persons living with HIV/AIDS (PLWHA). The Public Health Service Clinical Practice Guideline for Treating Tobacco Use and Dependence states that, during every medical encounter, all smokers should be offered smoking cessation counseling, along with approved medications. The Guideline also recognizes PLWHA as a priority population, given the scarcity of research on effective cessation treatments in this group. The scant evidence suggests that conventional treatments, though worthwhile, are not as successful as might be hoped for. The reasons for this are not entirely clear, but may have to do with the complex array of medical and psychosocial factors that complicate their lives. Clinicians should consider re-treatment strategies for those patients who encounter difficulty when quitting smoking with conventional approaches, switching or augmenting treatments as needed to minimize adverse
R. Niaura (*) Schroeder Institute for Tobacco Research and Policy Studies, Legacy, 1724 Massachusetts Avenue NW, Washington, DC 20036, USA e-mail: [email protected] C. Stanton Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA e-mail: [email protected] G. Chander : H. Hutton Johns Hopkins Medical Institutions, Johns Hopkins University, 1830 E. Monument Street, Office 8060, Baltimore, MD 21287, USA G. Chander e-mail: [email protected] H. Hutton e-mail: [email protected]
experiences, and to maximize tolerability, adherence, and cessation outcomes. Keywords Tobacco . Cigarette smoking . Smoking cessation . HIV/AIDS . Treatment . Adaptive treatment strategy . Bupropion . Varenicline . People living with HIV/ AIDS (PLWHA) . Behavioral aspects of HIV/AIDS
Introduction Smoking is the leading cause of preventable morbidity and mortality in the U.S. [1]. Among PLWHA, smoking prevalence is up to 3 times that of the general population [2–4]. Despite high levels of interest in quitting and past quit attempts [2, 5, 6], few PLWHA are able to sustain abstinence [2, 7, 8]. Smoking creates well-known risks for conditions such as cancer, stroke, heart disease, and chronic obstructive pulmonary disease [9•]. It also poses additional threats to PLWHA, such as pulmonary-related complications (bronchitis, pneumonia, and asthma) and increased incidence of opportunistic infections [10–15]. In addition to low baseline CD4 count and older age, current smoking is a strong independent predictor of mortality in PLWHA [16]. In the Strategies for Management of Antiretroviral Therapy clinical trial [17], the population attributable risk % for current vs former and never smokers c
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