Dr. Ronald ValdiserriAcross the country, many people are preparing to take an important step to improve their health tomorrow (11/15/2012); they are planning to quit smoking. Why tomorrow? It’s the 37thGreat American Smokeout. Organized annually by the American Cancer Society, the observance encourages smokers to use the date to make a plan to quit, or to plan in advance and quit smoking that day. By doing so, smokers—including those living with HIV—will be taking an important step towards a healthier life – one that can lead to reducing cancer and other health risks.Smoking and People Living with HIV
In the HRSA Guide for HIV/AIDS Clinical Care it is stated that smoking prevalence among people living with HIV/AIDS (PLWH) is estimated to be two to three times greater than in the general population, with estimates ranging from 50% to 70%. This higher smoking prevalence persists despite more than two decades of research that has concluded that smoking is a widespread problem and a major modifiable risk factor for disease and death in PLWH. That research has demonstrated that smokers with HIV/AIDS are more likely than PLWH who do not smoke to:
- Be at higher risk of a variety of tobacco-related conditions such as lung cancer, head and neck cancers, cervical and anal cancers, oral candidiasis, and oral hairy leukoplakia;
- Be more likely to develop bacterial pneumonia, Pneumocystis jiroveci pneumonia, other pulmonary conditions, and cardiovascular disease;
- Have a decreased immunologic and virologic response to antiretroviral therapy;
- Be non-adherent to treatment;
- Report lower quality of life than do nonsmoking persons with HIV/AIDS; and
- Have a greater chance of being diagnosed with an AIDS-defining condition or dying.(HRSA Guide for HIV/AIDS Clinical Care and Harris, 2010)
In a study of over 5,000 persons with HIV from over 30 countries, Dr. Alan Lifson and colleagues concluded that “current smoking represented a significant risk factor for both all-cause mortality and several serious clinical disease outcomes, such as cardiovascular disease, non-AIDS cancers, and bacterial pneumonia. Significant reductions in morbidity and mortality among HIV-infected patients achieved by advances in HIV therapy may be undercut by increases in adverse clinical outcomes attributable to smoking.”
In other words, quitting smoking may be one of the most important steps toward better health that a person living with HIV can take. If you are a smoker and would like to quit, our colleagues at smokefree.gov recommend that you START by taking these five important steps:
S = Set a quit date (even if it’s not tomorrow, use the Great American Smokeout as motivation to set the date that you’ll quit)T = Tell family, friends, and coworkers that you plan to quit.A = Anticipate and plan for the challenges you'll face while quitting.R = Remove cigarettes and other tobacco products from your home, car, and work.T = Talk to your doctor about getting help to quit.
Health Care Providers
That last tip underscores the important role that health care providers can play in encouraging and supporting people living with HIV to quit smoking. The Lifson study also concluded that encouraging smoking cessation should become a high priority for clinicians and other HIV service providers to promote health and reduce morbidity and mortality in their patients. Similarly, in its chapter on Smoking Cessation in the Guide for HIV/AIDS Clinical Care (2011), the Health Resources and Services Administration’s HIV/AIDS Bureau observes, “Although many care providers may feel that they can do little to affect the smoking behaviors of patients, evidence suggests that brief interventions by physicians are quite effective. Studies indicate that smoking cessation interventions as brief as 3 minutes in duration, when delivered by a physician, have a positive impact on abstinence rates of current smokers. Furthermore, studies have found that more than half of current HIV-infected smokers have expressed interest in, or have thought about, smoking cessation.”
To get ready to support PLWH who are prompted by the Smokeout or even a New Year’s Resolution to make the decision to quit smoking, HIV care providers may wish to review the Smoking Cessation chapter since it contains information on behavioral and pharmacologic interventions that may be useful in supporting patients seeking to quit.
Resources to Help You Quit SmokingAs you consider taking the health enhancing step of quitting smoking—or if you are supporting someone else in doing so, the following are some resources that may be helpful:
- CDC’s Office on Smoking and Health offers a wealth of information and tools including fact sheets, e-cards to encourage friends and loved ones who have chosen to quit smoking, FAQs, and other resources.
- Smokefree.gov provides free, accurate, evidence-based information and professional assistance to help support the immediate and long-term needs of people trying to quit smoking. Among their services is SmokefreeTXT, a mobile service designed for young adults providing 24/7 encouragement, advice, and tips to help smokers stop smoking for good. A Spanish language version of the site is available at https://espanol.smokefree.gov/.
- Itâs Time to Live: HIV and Smoking is a 12-page brochure, developed by the New York State Department of Health, that shows how HIV and smoking work together to harm your body. It explains how your health gets better as soon as you quit smoking and gives you advice on how to quit.