A smoking cessation programme in HIV-infected individuals: a pilot study
Luigia Elzi1, David Spoerl, Jacqueline Voggensperger
1Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel.
Insights
A smoking cessation program (SCP) for individuals with HIV significantly increased smoking abstinence rates at 12 months compared to controls. This intervention is feasible and should be encouraged to reduce cardiovascular disease (CVD) risk in this population.
Area of Science:
- Public Health
- Cardiology
- Infectious Diseases
Background:
- Antiretroviral therapy (ART) is linked to increased cardiovascular disease (CVD) risk.
- Smoking is the primary modifiable risk factor for CVD, particularly in individuals with HIV.
Purpose of the Study:
- To evaluate the effectiveness of a smoking cessation program (SCP) including counseling and nicotine replacement therapy in HIV-infected individuals.
- To assess the impact of smoking cessation on CVD morbidity and mortality in this population.
Main Methods:
- A prospective study evaluated an SCP intervention group (counseling and nicotine replacement therapy) against a control group not participating in the SCP.
- The primary endpoint was the smoking cessation rate at 12 months; secondary endpoints included CVD morbidity and mortality.
Main Results:
- The SCP achieved a 12-month smoking abstinence rate of 38% (13/34) compared to 7% (27/383) in the control group (OR 6.2).
- SCP participants had a higher 10-year CVD risk (11.2% vs. 8.5%).
- While two SCP participants had myocardial infarctions versus four controls, one control patient died of CVD.
Conclusions:
- Smoking cessation programs are feasible and beneficial for HIV-infected individuals.
- Further comparative trials are needed to confirm the long-term impact of smoking cessation on CVD outcomes in this population.
Background:
Antiretroviral therapy (ART) is a risk factor for cardiovascular disease (CVD) and smoking the most important modifiable cardiovascular risk factor.
Methods:
We prospectively evaluated a smoking cessation programme (SCP) in HIV-infected individuals (intervention: counselling and nicotine replacement therapy). Primary endpoint was the smoking cessation rate at 12 months; secondary endpoints were CVD morbidity and mortality. Controls were a not randomized control group of smokers not participating in the SCP.
Results:
Four-hundred and seventeen of 680 (61%) patients were smokers, and 34 of these participated in the SCP. Of these 34 individuals, 82% were male, the median age was 43 years, prior AIDS was recorded in 29%, and depressive disorder was recorded in 18/%. Twenty-five (74%) patients were receiving ART. Additional risk factors were dyslipidaemia (68%), a prior cardiovascular event (24%), hypertension (1 5%), and a family history of CVD in 2/34 (6%) individuals. According to the Framingham equation, the 10-year risk of CVD was higher in SCP participants than in controls (11.2% versus 8.5%, P=0.06). At termination of the SCP, 17/34 (50%) individuals had stopped smoking compared with 57/383 (15%) controls. Self-reported smoking abstinence for a12 months was 13/34 (38%) in the intervention group and 27/383 (7%) in the control group (odds ration 6.2, 95% confidence interval 2.8-14.3). During the follow-up, two SCP participants and 4 controls experienced a myocardial infarction. One patient in the control group died of CVD.
Conclusions:
SCP in HIV-infected individuals is feasible and should be encouraged. The long-term impact of smoking cessation on CVD morbidity and mortality should be evaluated in comparative trials.
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