Patients With HIV More Likely to Smoke, Less Likely to Quit

Diana Swift

March 03, 2015

Of the estimated 419,945 US adults receiving medical care for HIV infection, more than 4 in 10 are current smokers, almost twice as many as in the general population, according to a survey-based Centers for Disease Control and Prevention (CDC) analysis. Furthermore, patients with HIV are less likely to quit smoking than their general population counterparts, notes the study, published in the March 3 issue of the Annals of Internal Medicine.

Smoking's negative synergistic effects with HIV substantially reduce the benefits of effective antiviral treatment and increase the risk for illness and death.

There is clearly a role for professionals treating this population. "For persons with HIV who receive care regularly, providers have a unique opportunity to promote smoking cessation interventions during visits," write Rennatus Mdodo, DrPH, from the Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Office of Infectious Diseases, CDC, Atlanta, Georgia, and colleagues.

To estimate smoking prevalence in adults with HIV vs the general population, the authors used data collected in 2009 by the Medical Monitoring Project, an HIV surveillance system, and data from the 2009 National Health Interview Study, a cross-sectional household survey. Results for patients with HIV were based on face-to-face interviews plus medical record abstractions from 461 responding Medical Monitoring Project facilities in which 4217 individuals completed interviews linked with medical record abstractions. The researchers compared data, which included several sociodemographic and behavioral variables, with information from 27,731 National Health Interview Study participants.

HIV adults were predominantly male (71.2%), older than 40 years (75.4%), and non-Hispanic black (41.4%). Half had more than a high school education (50.6%), and 54.3% lived at or above the federal poverty level.

In the HIV group, 42.4% (95% confidence interval [CI], 39.7% - 45.1%) were current smokers compared with 20.6% (95% CI, 19.9% - 21.3%) of the National Health Interview Study adults. Fewer participants in the HIV group were never-smokers (37.3% [95% CI, 34.9% - 39.6%] vs 57.5% [95% CI, 56.6% - 58.4%]). About one in five participants in both groups were former smokers.

In the HIV group, the smoking rate was lowest in among Hispanics and Latinos (35.0%) and highest among persons incarcerated in the 12 months before interviewing (67.8%). Factors, some of which are modifiable, independently associated with current smoking included male sex, age 40 to 49 years, non-Hispanic white/black ethnicity, having no more than a high school education, living below the poverty level, and homelessness or incarceration in the last 12 months. Other factors fuelling smoking likelihood were noninjectable drug use, binge drinking, and failure to achieve viral suppression.

In the general population as well, male sex, older age, non-Hispanic white/black ethnicity, and low education levels were associated with smoking.

As for cessation, the HIV group was also less likely than the general adult population to quit: 32.4% (95% CI, 29.6% - 35.3%) of ever-smokers vs 51.7% (95% CI, 50.3% - 53.0%) of all adults.

Although evidence-based smoking cessation interventions and clinical guidelines have been developed for the population at large, they have not been fully implemented for HIV-infected persons, who may face additional challenges such as substance abuse and poverty. The CDC has recently launched a national antismoking campaign for smokers with HIV.

The authors recommend that smoking cessation programs be a routine component of healthcare for patients with HIV. "Provider-initiated quitting discussions and expanded access to evidence-based smoking cessation interventions for adults with HIV may help increase quit rates and reduce morbidity and mortality rates associated with smoking," they write.

This work was supported by the CDC under an agreement with the Medical Monitoring Project. The CDC had no input into the study design and execution but approved the final version. The authors have disclosed no relevant financial relationships.

Ann Intern Med. 2015;162:335-344. Abstract

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