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Harm reduction for smokers living with HIV.
Jonathan Shuter1, Krishna P Reddy2, Emily P Hyle3
1Department of Medicine and Department of Epidemiology and Population Health, Division of Infectious Diseases, Albert Einstein College of Medicine, Bronx, NY, USA.
The Lancet. HIV
|August 30, 2021
Summary
Tobacco use is a leading cause of death for people with HIV. A harm reduction approach, including reduced smoking and managing health risks, is crucial for those unable or unwilling to quit.
Area of Science:
- Public Health
- HIV Medicine
- Addiction Science
Background:
- Tobacco use is a primary cause of mortality among individuals living with HIV (PLWH) in the USA.
- Current tobacco cessation strategies, including behavioral and pharmacological therapies, show limited long-term efficacy in PLWH.
- General tobacco treatment approaches may be inadequate for PLWH, a significant population segment.
Purpose of the Study:
- To advocate for a harm reduction strategy for smokers living with HIV.
- To propose an expanded definition of harm reduction for this population.
- To address the challenges in optimizing tobacco treatment for PLWH.
Main Methods:
- Literature review and synthesis of current tobacco treatment strategies for PLWH.
- Analysis of the limitations of traditional cessation models in this demographic.
- Conceptual framework development for an expansive harm reduction approach.
Main Results:
- Traditional cessation methods have shown disappointing long-term efficacy in PLWH.
- Most smokers living with HIV continue to smoke despite intensive treatments.
- An expanded harm reduction approach is necessary and sensible.
Conclusions:
- A generalized approach to tobacco treatment may not serve PLWH effectively.
- Harm reduction, encompassing reduced cigarette intake and managing health consequences, is vital for smokers living with HIV.
- Integrating lung cancer screening and managing cardiovascular risk factors (hypertension, hyperlipidaemia) are key components of this expanded harm reduction strategy.
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