SMOKING CESSATION

Smoking cessation should be encouraged as a priority in health self-management for people with HIV1:

  • Smokers with HIV are:
    • More likely to contract other serious illnesses than nonsmokers with HIV1
    • Less likely to respond to antiretroviral therapy (ART)1

The smoking rate in HIV-infected people is 2 to 3 times higher than in the general population1


HIV-infected smokers appear to be at higher risk of many tobacco-related conditions than smokers who don’t have HIV. These include lung cancer, head and neck cancers, cervical and anal cancers, oral candidiasis, and oral hairy leukoplakia.1 HIV-infected smokers are also more likely to develop bacterial pneumonia, pneumocystis pneumonia, and other pulmonary conditions.1 According to a cohort study of HIV patients followed from 1995-20102:

  • The life expectancy of current smokers, previous smokers, and those who never smoked varied based on smoking status. The loss of life-years for HIV-infected individuals from smoking was twice as high as that associated with HIV alone
  • The chance of non-AIDS-related death is 5 times greater for people with HIV who smoke compared to those who never smoked. For those current smokers with HIV, there is a marked increased risk of death caused by cardiovascular disease and cancer and increased risk of AIDS-related death


SMOKING CESSATION
INTERVENTIONS

More than half of current HIV-infected smokers have an interest in or have considered quitting.1 Patients should be educated about the specific health benefits of smoking cessation for people living with HIV3:

  • Improved immune function3
  • Decreased risk of cardiovascular events3

FIVE A'S OF SMOKING CESSATION COUNSELING3,4

It is recommended by DHHS to “Ask,” “Advise,” and “Assess” any patient regardless of their willingness to quit, to offer to “Assist” and “Arrange” for patients who have expressed willingness to quit smoking, and to also “Arrange” follow-up for patients who are not willing to stop smoking.1,4 Practitioners would be responsible for follow-up and should arrange to address tobacco dependence at the next clinic visit.4


Smoking cessation interventions of 10 minutes or less have a proven positive impact on helping smokers quit5


REFERENCES:
  1. U.S. Department of Health and Human Services. Health Resources and Services Administration. Guide for HIV/AIDS Clinical Care—2014 Edition. Rockville, MD: U.S. Department of Health and Human Services; 2014.
  2. Helleberg M, Afzal S, Kronborg G, et al. Mortality attributable to smoking among HIV-1-infected individuals: a nationwide, population-based cohort study. Clin Infect Dis. 2013;56(5):727-734.
  3. Moscou-Jackson G, Commodore-Mensah Y, Farley J, DiGiacomo M. Smoking-cessation interventions in people living with HIV infection: a systematic review. J Assoc Nurses AIDS Care. 2014;25(1):32-45.
  4. Fiore MC, Jaén CR, Baker TB, et al. Treating Tobacco Use and Dependence: 2008 Update. Rockville, MD: U.S. Department of Health and Human Services; May 2008.
  5. Centers for Disease Control and Prevention. CDC fact sheet: quitting smoking. Available at
    https://www.cdc.gov/tobacco/data_statistics/fact_sheets/cessation/quitting/. Accessed June 27, 2017.