Surviving HIV and dying for a smoke: Implications for tobacco use among people living with HIV

Abstract

Background: Since the advent of highly active antiretroviral therapy in the mid-nineties, deaths among persons living with HIV (PLWH) have declined nationally. Now a controllable condition, HIV has become a chronic disease, highlighting the importance of tobacco cessation in lowering morbidity and premature mortality. Current smoking is approximately twice as high among PLWH compared with the general population. PLWH who smoke experience higher rates of cardiovascular disease, AIDS-defining illnesses, and cancer than PLWH who do not smoke. Loss of life-years associated with smoking among PLWH is greater than life-years lost from HIV. Methods: Data on current smoking, derived from the 2009-12 Georgia Medical Monitoring Project (MMP) were analyzed. Smoking rates were calculated by demographic characteristics, and results were compared to those from the 2011 Georgia Behavioral Risk Factor Surveillance System (BRFSS), a population-based telephone survey. Results: The prevalence of current smoking among PLWH was 36.1%, compared with 21.2% among the general population in Georgia. Smoking prevalence for PLWH generally varied by demographic characteristics according to the same pattern as for the general population, but prevalence was consistently higher among PLWH. Conclusions: The prevalence of current smoking among PLWH in Georgia is high. Clinical and public health interventions must address smoking cessation as part of HIV care to prevent disease, improve quality of life, and reduce mortality. HIV-infected smokers have more barriers to quitting (alcohol, depression, drug dependence, and inaccurate risk perception) and a lower quit rate than non-HIV-infected smokers. Efficacy studies of behavioral and pharmacological interventions for smoking cessation specific to PLWH are needed.