Smoking Cessation in People Living With HIV: Results From Italian STOPSHIV Project Cohort

Assessment of real-life effectiveness of an intervention for smoking cessation in people living with HIV (PLWH) in long-term follow-up.

Multicenter cohort prospective study, involving PLWH from Italian Infectious Disease Centers.

During routine HIV care, clinicians usually promote smoking cessation implementing the European AIDS Clinical Society guidelines. We analyzed smoking cessation for 9 years of follow-up. The brief counseling intervention was defined "standard" when delivered in at least half follow-up visits, "soft" if less than half. We excluded from the analysis 85 patients lost at follow-up. The main outcome was definitive smoking interruption at the last follow-up visit (smoking abstinence for >6 months and no recurrence). Abstinence predictors were evaluated using a Cox-proportional hazard regression model [adjusted hazard ratio (aHR), and 95% confidence interval (CI)].

Out of 1002 PLWH with prolonged follow-up, 510 were current smokers at baseline (median observation time was 7.4 years, interquartile range 6.9-8.0). The standard intervention was performed in 340 smokers (66.7%) and soft intervention in the remaining 170 (33.3%). At the last visit, 66 (12.9%) PLWH achieved self-reported definitive smoking cessation, 59 (17.4%) in standard and 7 (4.1%) in soft intervention. At the multivariate analysis, Fagerström score (by -1, aHR 1.16, 95% CI: 1.05 to 1.29), stage of change (preparation/action aHR 3.33, 95% CI: 1.81 to 6.12), and standard intervention (aHR 2.45, 95% CI: 1.08 to 5.58) were predictors of smoking cessation.

The brief intervention led to self-reported definite smoking cessation in 12.9% of PLWH. The standard intervention was more effective: thus, adherence to intervention emerged as a critical factor for the effectiveness.