More HIV Smokers and Fewer Quitters

April 6, 2015

Screening for tobacco use and strategies for quitting are important considerations for patients with HIV, since infected adults are more likely to smoke -- and less likely to quit -- than those who are uninfected.

More than 40% of US adults receiving medical care for HIV infection are current smokers-- almost twice as many as in the general population, according to a new survey-based analysis. What’s more, HIV patients are less likely to quit smoking than their general population counterparts.

Therefore, "tobacco screening and cessation strategies are important considerations as part of routine HIV care. For persons with HIV who receive care regularly, providers have a unique opportunity to promote smoking cessation interventions during visits," state the authors of a new study, led by 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, GA.

The negative health effects of cigarette smoking and HIV infection are synergistic, they note.

Mdodo and colleagues set out to compare the prevalence of current cigarette smoking and smoking cessation between adults with HIV receiving medical care and adults in the general population. They 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 more than 4200 individuals completed interviews linked with medical record abstractions. The researchers compared data, which included several socio-demographic and behavioral variables, with information from more than 27,000 National Health Interview Study participants.

HIV adults were predominantly male, older than 40 years, and non-Hispanic black. In the HIV group, 42.4% were current smokers compared with 20.6% of the National Health Interview Study adults. Slightly more than one-third in the HIV group and slightly more than half in the National Health Interview Study group were never-smokers. About 20% in both groups were former smokers.

The HIV group was also less likely to quit (32.4%) than the general adult population (51.7%).

Among those with HIV, the smoking rate was lowest in Hispanics and Latinos (35%) and highest among those incarcerated in the 12 months before interviewing (67.8%). Among adults with HIV, factors independently associated with greater smoking prevalence were older age, non-Hispanic white or non-Hispanic black race, lower educational level, poverty, homelessness, incarceration, substance use, binge alcohol use, depression, and not achieving a suppressed HIV viral load.

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

Evidence-based smoking cessation interventions and clinical guidelines have not been fully implemented for HIV-infected persons. The CDC has recently launched a national antismoking campaign for smokers with HIV.

The authors recommend smoking cessation programs become routine 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 state.

The researchers published their results in the March 3, 2015 issue of the Annals of Internal Medicine.