Cigarette smoking in PrEP recipients: a challenge and an opportunity

The increase in HIV pre-exposure prophylaxis (PrEP) uptake presents both challenges and opportunities. The process of initiating and continuing PrEP brings the medical care establishment into direct and ongoing contact with a young population that is often otherwise unengaged with health-care systems. The groups at highest risk for HIV acquisition, including PrEP recipients, have high rates of tobacco use, which remains the leading cause of preventable death in the world. However, there has been little attention paid to tobacco use and cessation treatment in the context of PrEP care. PrEP guidelines and tobacco use treatment guidelines do not mention the issue of tobacco use in PrEP recipients, and medical literature pertaining to this subject is virtually non-existent. Public health investments that focus on reducing the immediate risk of HIV acquisition have not been accompanied by sufficient investment aimed at mitigating the long-term harms of tobacco use within the same target population. This Viewpoint discusses easy and efficient strategies that might be used to promote tobacco use cessation in PrEP care settings and encourages health-care providers and policy makers to seize this opportunity.