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McClure JB, Heffner JL, Krakauer C, Mun S, Catz SL. A Novel mHealth App for Smokers Living With HIV Who Are Ambivalent About Quitting Smoking: Formative Research and Randomized Feasibility Study. JMIR Form Res 2024; 8:e58063. [PMID: 38976321 PMCID: PMC11263889 DOI: 10.2196/58063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 05/14/2024] [Indexed: 07/09/2024] Open
Abstract
BACKGROUND More people who smoke and are living with HIV now die from tobacco-related diseases than HIV itself. Most people are ambivalent about quitting smoking and want to quit someday but not yet. Scalable, effective interventions are needed to motivate and support smoking cessation among people ambivalent about quitting smoking (PAQS) who are living with HIV. OBJECTIVE This study aims to develop an app-based intervention for PAQS who are living with HIV and assess its feasibility, acceptability, and potential impact. Results of this study will inform plans for future research and development. METHODS In phase 1, PAQS living with HIV (n=8) participated in user-centered design interviews to inform the final intervention app design and recruitment plan for a subsequent randomized pilot study. In phase 2, PAQS living with HIV were randomized to either a standard care control app or a similar experimental app with additional content tailored for PAQS and those with HIV. Participants were followed for 3 months. Feasibility focused on recruitment, retention, and participants' willingness to install the app. The study was not powered for statistical significance. Indices of acceptability (satisfaction and use) and impact (smoking behavior change and treatment uptake) were assessed via automated data and self-report among those who installed and used the app (n=19). RESULTS Recruitment for both study phases was a challenge, particularly via web-based and social media platforms. Enrollment success was greater among people living with HIV recruited from a health care provider and research registry. Once enrolled, retention for the phase 2 randomized study was good; 74% (14/19) of the participants completed the 3-month follow-up. Phase 1 findings suggested that PAQS living with HIV were receptive to using an app-based intervention to help them decide whether, when, and how to stop smoking, despite not being ready to quit smoking. Phase 2 findings further supported this conclusion based on feedback from people who agreed to use an app, but group differences were observed. Indices of acceptability favored the experimental arm, including a descriptively higher mean number of sessions and utilization badges. Similarly, indices of potential impact were descriptively higher in the experimental arm (proportion reducing smoking, making a quit attempt, or calling free tobacco quitline). No participants in either arm quit smoking at the 3-month follow-up. CONCLUSIONS On the basis of this formative work, PAQS living with HIV may be receptive to using a mobile health-based app intervention to help them decide whether, when, or how to stop using tobacco. Indices of acceptability and impact indicate that additional research and development are warranted. TRIAL REGISTRATION ClinicalTrials.gov NCT05339659; https://clinicaltrials.gov/study/NCT05339659.
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Affiliation(s)
- Jennifer B McClure
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States
- Kaiser Permanente Bernard J Tyson School of Medicine, Pasadena, CA, United States
| | | | - Chloe Krakauer
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States
| | - Sophia Mun
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States
| | - Sheryl L Catz
- Betty Irene Moore School of Nursing, University of California, Davis, Sacramento, CA, United States
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Bada F, Mansfield ME, Okui L, Montebatsi M, DiClemente C, Tapera R, Ikgopoleng K, Mokonopi S, Magidson JF, Onukwugha E, Ndwapi N, Himelhoch S, Mbongwe B, Charurat M. Design and rationale of the Botswana Smoking Abstinence Reinforcement Trial: a protocol for a stepped-wedge cluster randomized trial. Implement Sci Commun 2024; 5:53. [PMID: 38720363 PMCID: PMC11077839 DOI: 10.1186/s43058-024-00588-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 04/25/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND With expanded and sustained availability of HIV treatment resulting in substantial improvements in life expectancy, the need to address modifiable risk factors associated with leading causes of death among people living with HIV/AIDS (PLWH), such as tobacco smoking, has increased. Tobacco use is highly prevalent among PLWH, especially in southern Africa, where HIV is heavily concentrated, and many people who smoke would like to quit but are unable to do so without assistance. SBIRT (Screening, Brief Intervention and Referral to Treatment) is a well-established evidence-based approach successful at supporting smoking cessation in a variety of settings. Varenicline is efficacious in supporting smoking cessation. We intend to assess the effectiveness of SBIRT and varenicline on smoking cessation among PLWH in Botswana and the effectiveness of our implementation. METHODS BSMART (Botswana Smoking Abstinence Reinforcement Trial) is a stepped-wedge, cluster randomized, hybrid Type 2 effectiveness-implementation study guided by the RE-AIM framework, to evaluate the effectiveness and implementation of an SBIRT intervention consisting of the 5As compared to an enhanced standard of care. SBIRT will be delivered by trained lay health workers (LHWs), followed by referral to treatment with varenicline prescribed and monitored by trained nurse prescribers in a network of outpatient HIV care facilities. Seven hundred and fifty people living with HIV who smoke daily and have been receiving HIV care and treatment at one of 15 health facilities will be recruited if they are up to 18 years of age and willing to provide informed consent to participate in the study. DISCUSSION BSMART tests a scalable approach to achieve and sustain smoking abstinence implemented in a sustainable way. Integrating an evidence-based approach such as SBIRT, into an HIV care system presents an important opportunity to establish and evaluate a modifiable cancer prevention strategy in a middle-income country (MIC) setting where both LHW and non-physician clinicians are widely used. The findings, including the preliminary cost-effectiveness, will provide evidence to guide the Botswanan government and similar countries as they strive to provide affordable smoking cessation support at scale. CLINICAL TRIAL REGISTRATION NCT05694637 Registered on 7 December 2022 on clinicaltrials.gov, https://clinicaltrials.gov/search?locStr=Botswana&country=Botswana&cond=Smoking%20Cessation&intr=SBIRT.
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Affiliation(s)
- Florence Bada
- Division of Epidemiology and Prevention, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA.
| | - Megan E Mansfield
- Division of Epidemiology and Prevention, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Lillian Okui
- Botswana University of Maryland Medicine Health Initiative, Gaborone, Botswana
| | - Milton Montebatsi
- Botswana University of Maryland Medicine Health Initiative, Gaborone, Botswana
| | - Carlo DiClemente
- Department of Psychology, University of Maryland Baltimore County, Baltimore, MD, USA
| | - Roy Tapera
- School of Public Health, University of Botswana, Gaborone, Botswana
- Anti-Tobacco Network, University of Botswana, Gaborone, Botswana
| | - Kaizer Ikgopoleng
- Botswana University of Maryland Medicine Health Initiative, Gaborone, Botswana
| | - Selebaleng Mokonopi
- Botswana University of Maryland Medicine Health Initiative, Gaborone, Botswana
| | - Jessica F Magidson
- Department of Psychology and the Center for Substance Use, Addiction & Health Research (CESAR), University of Maryland, College Park, Maryland, USA
| | - Eberechukwu Onukwugha
- Department of Practice, Sciences, and Health Outcomes Research, University of Maryland School of Pharmacy, Baltimore, MD, USA
| | - Ndwapi Ndwapi
- Botswana University of Maryland Medicine Health Initiative, Gaborone, Botswana
| | - Seth Himelhoch
- Department of Psychiatry, University of Kentucky School of Medicine, Lexington, KY, USA
| | - Bontle Mbongwe
- School of Public Health, University of Botswana, Gaborone, Botswana
- Anti-Tobacco Network, University of Botswana, Gaborone, Botswana
| | - Man Charurat
- Division of Epidemiology and Prevention, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA
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Himelhoch S, Kelly D, deFilippi C, Taylor G, Bennett M, Medoff D, Li L, Christenson R, Potts W, Shuter J. Optimizing behavioral and pharmacological smoking cessation interventions among people with HIV. AIDS 2024; 38:669-678. [PMID: 38126353 DOI: 10.1097/qad.0000000000003821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
BACKGROUND People with HIV/AIDS (PWH) smoke at nearly three times the rate of the general population. Interventions to promote sustained quitting among PWH are urgently needed. METHODS Our study used a randomized factorial design to evaluate the effects of varenicline, compared with placebo, and behavioral cessation therapy, positively smoke free (PSF), compared with standard of care (SOC) among PWH who smoke. The study was designed with power to detect a small effect (Cohen's h of 0.28-0.36) with 240 participants. The primary outcome was the 7-day point prevalence abstinence (PPA) confirmed by exhaled carbon monoxide (ECO) less than 10 ppm for both main effects at 36 weeks. The study was conducted from June 2016 to November 2020. During the study's last year, recruitment was halted because of COVID-19. RESULTS The study randomized 184 participants with power to detect a medium effect (Cohen's h of 0.41). Participants were mostly African American (89.7%), men (62.8%) who smoked mentholated cigarettes (96.7%). Nearly all received antiretroviral medication (96.2%). Quit rates for the entire sample were 7.5% at 36 weeks. Compared with those who received placebo, neither those who received varenicline [36 weeks; OR (95% CI), 1.31 (0.33-5.22), P = 0.70] nor PSF [36 weeks; OR (95% CI), 0.26 (0.03-2.44), P = 0.24) were more likely to quit smoking. CONCLUSION Among an urban living, primarily African American sample of PWH who smoke neither varenicline nor PSF was found to be efficacious at 36 weeks. Our study was not powered to detect small effects sizes. Larger trials are needed to establish tobacco treatment standards for PWH who smoke.
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Affiliation(s)
- Seth Himelhoch
- University of Kentucky College of Medicine, Lexington, Kentucky
- University of Maryland School of Medicine, Baltimore, Maryland
| | - Deana Kelly
- University of Maryland School of Medicine, Baltimore, Maryland
| | | | - Gregory Taylor
- University of Maryland School of Medicine, Baltimore, Maryland
| | - Melanie Bennett
- University of Maryland School of Medicine, Baltimore, Maryland
| | - Deborah Medoff
- University of Maryland School of Medicine, Baltimore, Maryland
| | - Lan Li
- University of Maryland School of Medicine, Baltimore, Maryland
| | | | - Wendy Potts
- University of Maryland School of Medicine, Baltimore, Maryland
| | - Jonathan Shuter
- Albert Einstein College of Medicine, New York City, New York, USA
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Wirtz MR, Stanton AM, Manohar R, Labbe AK, Zvolensky MJ, Smits JAJ, Hoeppner B, O’Cleirigh C. The Relationship Between Cigarette Dependence and Cessation Methods: Implications for Smoking Cessation Among People With HIV. J Stud Alcohol Drugs 2023; 84:772-780. [PMID: 37219036 PMCID: PMC10600974 DOI: 10.15288/jsad.22-00318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 05/08/2023] [Indexed: 05/24/2023] Open
Abstract
OBJECTIVE These analyses investigate how dependence may be related to cessation method choice and how this relationship may vary by subpopulation among people with HIV (PWH) who smoke cigarettes. METHOD PWH who smoke (N = 71) were recruited from clinics in Boston, MA. The Fagerström Test for Nicotine Dependence (FTND) and Smoking History Questionnaire (SHQ) were completed to assess for cigarette dependence, past-week cigarettes per day (CPD), and past cessation method use. Logistic regression examined the association between dependence and previous cessation methods for the whole sample, and moderation analyses assessed this relationship by age and race. RESULTS Higher FTND was associated with less use of behavioral modification methods (odds ratio [OR] = 0.658, 95% CI [0.435, 0.994], p = .047). Higher past-week CPD was associated with use of the American Cancer Society/American Lung Association (ACS/ALA) programs (OR = 1.159, 95% CI [1.011, 1.328], p = .035) and telephone counselling (OR = 1.142, 95% CI [1.006, 1.295], p = .040]). Older participants with more past-week CPD were more likely to have used the ACS/ALA programs (B = 0.0169, 95% CI [0.0008, 0.0331], p = .0401), and White participants with more past-week CPD were less likely to have tried to quit "cold turkey" (B = 0.1676, 95% CI [0.0027, 0.3326], p = .0464). CONCLUSIONS These preliminary results suggest that there is likely not a "one-size-fits-all" approach to cessation for PWH who smoke, especially within subpopulations (i.e., age and race). Implications include ensuring access to multiple cessation methods, identifying methods that could be culturally appropriate outside of the clinical intervention setting, and providing education and support on cessation methods offered.
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Affiliation(s)
- Megan R. Wirtz
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
- The Graduate Center, City University of New York, New York, New York
| | - Amelia M. Stanton
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
- Department of Psychological and Brain Sciences, Boston University, Boston, Massachusetts
- The Fenway Health Institute, Fenway Health, Boston, Massachusetts
| | - Rohin Manohar
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
| | - Allison K. Labbe
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Michael J. Zvolensky
- Department of Psychology, University of Houston, Houston, Texas
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, Texas
- HEALTH Institute, University of Houston, Houston, Texas
| | | | - Bettina Hoeppner
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Conall O’Cleirigh
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
- The Fenway Health Institute, Fenway Health, Boston, Massachusetts
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
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Edwards JK, Cole SR, Breger TL, Filiatreau LM, Zalla L, Mulholland GE, Horberg MA, Silverberg MJ, John Gill M, Rebeiro PF, Thorne JE, Kasaie P, Marconi VC, Sterling TR, Althoff KN, Moore RD, Eron JJ. Five-Year Mortality for Adults Entering Human Immunodeficiency Virus Care Under Universal Early Treatment Compared With the General US Population. Clin Infect Dis 2022; 75:867-874. [PMID: 34983066 PMCID: PMC9477443 DOI: 10.1093/cid/ciab1030] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Mortality among adults with human immunodeficiency virus (HIV) remains elevated over those in the US general population, even in the years after entry into HIV care. We explore whether the elevation in 5-year mortality would have persisted if all adults with HIV had initiated antiretroviral therapy within 3 months of entering care. METHODS Among 82 766 adults entering HIV care at North American AIDS Cohort Collaboration clinical sites in the United States, we computed mortality over 5 years since entry into HIV care under observed treatment patterns. We then used inverse probability weights to estimate mortality under universal early treatment. To compare mortality with those for similar individuals in the general population, we used National Center for Health Statistics data to construct a cohort representing the subset of the US population matched to study participants on key characteristics. RESULTS For the entire study period (1999-2017), the 5-year mortality among adults with HIV was 7.9% (95% confidence interval [CI]: 7.6%-8.2%) higher than expected based on the US general population. Under universal early treatment, the elevation in mortality for people with HIV would have been 7.2% (95% CI: 5.8%-8.6%). In the most recent calendar period examined (2011-2017), the elevation in mortality for people with HIV was 2.6% (95% CI: 2.0%-3.3%) under observed treatment patterns and 2.1% (.0%-4.2%) under universal early treatment. CONCLUSIONS Expanding early treatment may modestly reduce, but not eliminate, the elevation in mortality for people with HIV.
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Affiliation(s)
- Jessie K Edwards
- Department of Epidemiology, University of North Carolina at Chapel Hill, North Carolina, USA
| | - Stephen R Cole
- Department of Epidemiology, University of North Carolina at Chapel Hill, North Carolina, USA
| | - Tiffany L Breger
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Lindsey M Filiatreau
- Department of Epidemiology, University of North Carolina at Chapel Hill, North Carolina, USA
| | - Lauren Zalla
- Department of Epidemiology, University of North Carolina at Chapel Hill, North Carolina, USA
| | - Grace E Mulholland
- Department of Epidemiology, University of North Carolina at Chapel Hill, North Carolina, USA
| | - Michael A Horberg
- Kaiser Permanent Mid-Atlantic Permanente Research Institute, Rockville, Maryland, USA
| | | | - M John Gill
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Peter F Rebeiro
- Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Jennifer E Thorne
- School of Medicine, Johns Hopkins University, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Parastu Kasaie
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Vincent C Marconi
- School of Medicine, and Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Timothy R Sterling
- Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, USAand
| | - Keri N Althoff
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Richard D Moore
- School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Joseph J Eron
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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McGinnis KA, Skanderson M, Justice AC, Tindle HA, Akgün KM, Wrona A, Freiberg MS, Goetz MB, Rodriguez-Barradas MC, Brown ST, Crothers KA. Using the biomarker cotinine and survey self-report to validate smoking data from United States Veterans Health Administration electronic health records. JAMIA Open 2022; 5:ooac040. [PMID: 37252267 PMCID: PMC9154288 DOI: 10.1093/jamiaopen/ooac040] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 05/04/2022] [Accepted: 05/19/2022] [Indexed: 06/16/2024] Open
Abstract
OBJECTIVE Tobacco use/smoking for epidemiologic studies is often derived from electronic health record (EHR) data, which may be inaccurate. We previously compared smoking from the United States Veterans Health Administration (VHA) EHR clinical reminder data with survey data and found excellent agreement. However, the smoking clinical reminder items changed October 1, 2018. We sought to use the biomarker salivary cotinine (cotinine ≥30) to validate current smoking from multiple sources. MATERIALS AND METHODS We included 323 Veterans Aging Cohort Study participants with cotinine, clinical reminder, and self-administered survey smoking data from October 1, 2018 to September 30, 2019. We included International Classification of Disease (ICD)-10 codes F17.21 and Z72.0. Operating characteristics and kappa statistics were calculated. RESULTS Participants were mostly male (96%), African American (75%) and mean age was 63 years. Of those identified as currently smoking based on cotinine, 86%, 85%, and 51% were identified as currently smoking based on clinical reminder, survey, and ICD-10 codes, respectively. Of those identified as not currently smoking based on cotinine, 95%, 97%, and 97% were identified as not currently smoking based on clinical reminder, survey, and ICD-10 codes. Agreement with cotinine was substantial for clinical reminder (kappa = .81) and survey (kappa = .83), but only moderate for ICD-10 (kappa = .50). DISCUSSION To determine current smoking, clinical reminder, and survey agreed well with cotinine, whereas ICD-10 codes did not. Clinical reminders could be used in other health systems to capture more accurate smoking information. CONCLUSIONS Clinical reminders are an excellent source for self-reported smoking status and are readily available in the VHA EHR.
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Affiliation(s)
| | | | - Amy C Justice
- VA Connecticut Healthcare System, West Haven, Connecticut, USA
- Department of Medicine, Yale University, New Haven, Connecticut, USA
| | - Hilary A Tindle
- Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
- Veterans Health Administration-Tennessee Valley Healthcare System Geriatric Research, Education and Clinical Center (GRECC), Nashville, Tennessee, USA
| | - Kathleen M Akgün
- Department of Medicine, Yale University, New Haven, Connecticut, USA
| | - Aleksandra Wrona
- VA Connecticut Healthcare System, West Haven, Connecticut, USA
- Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
- Veterans Health Administration-Tennessee Valley Healthcare System Geriatric Research, Education and Clinical Center (GRECC), Nashville, Tennessee, USA
| | - Matthew S Freiberg
- Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
- Veterans Health Administration-Tennessee Valley Healthcare System Geriatric Research, Education and Clinical Center (GRECC), Nashville, Tennessee, USA
| | - Matthew Bidwell Goetz
- VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
- David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Maria C Rodriguez-Barradas
- Infectious Diseases Section, Department of Medicine, Michael E. DeBakey VAMC, Baylor College of Medicine, Houston, Texas, USA
| | | | - Kristina A Crothers
- Department of Medicine, Harborview Medical Center, University of Washington, Seattle, Washington, USA
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Colliding Epidemics: Research Gaps and Implementation Science Opportunities for Tobacco Use and HIV/AIDS in Low- and Middle-Income Countries. J Smok Cessat 2022; 2022:6835146. [PMID: 35821759 PMCID: PMC9232349 DOI: 10.1155/2022/6835146] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 06/02/2022] [Indexed: 11/22/2022] Open
Abstract
Introduction Tobacco use is a leading cause of cancer death among people living with HIV (PLWH) worldwide, and smoking prevalence tends to be higher among PLWH. The burden of both HIV/AIDS and tobacco use is increasingly concentrated in low- and middle-income countries (LMICs), where resources to address these challenges are often limited. However, there has been limited effort to date to integrate tobacco cessation into HIV programs in LMICs. Methods We searched the literature (searching was conducted between October 1 and December 31, 2020) using PubMed including search terms “tobacco” and “HIV” and “cessation” over the past ten years (searching for articles published between December 1, 2010, and December 1, 2020) to identify original research studies on tobacco cessation interventions conducted in LMICs for PLWH. We also conducted an analysis of NCI-funded research grants on tobacco cessation and HIV awarded during fiscal years 2010 to 2020. Results and Discussion. Existing evidence suggests that conventional tobacco cessation treatments may be less effective among PLWH. Moreover, while substantial evidence exists to support a range of cessation interventions, most of this evidence comes from HICs and is only partly applicable to the evolving social, economic, and cultural climate of many LMICs. There is an urgent need to develop, adapt, and implement effective tobacco control and cessation interventions targeted to PLWH in LMICs, as well as to generate evidence from these settings. Implementation science provides tools develop and test strategies to overcome barriers and to integrate and scale up cessation services within existing HIV treatment settings. Conclusion There is a unique opportunity to address HIV and tobacco use in a coordinated way in LMICs by integrating evidence-based tobacco cessation into HIV programs.
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McClure JB, Catz SL, Chalal C, Ciuffetelli R, Coggeshall S, DeFaccio RJ, Fleehart S, Heffner JL, Thompson E, Williams EC, Crothers K. Design and methods of a randomized trial testing the novel Wellness Intervention for Smokers Living with HIV (WISH). Contemp Clin Trials 2021; 110:106486. [PMID: 34776121 DOI: 10.1016/j.cct.2021.106486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 06/09/2021] [Accepted: 06/11/2021] [Indexed: 10/20/2022]
Abstract
Smoking rates are disproportionately high among people living with HIV. Smokers living with HIV (SLWH) are also largely unaware of the HIV-specific deleterious effects of smoking and often lack motivation and confidence in their ability to quit tobacco. To address these issues, we developed the Wellness Intervention for Smokers Living with HIV (WISH). WISH is grounded in the Information-Motivation-Behavioral Skills (IMB) Model and is designed for all SLWH, regardless of their initial motivation to quit. It follows evidence-based, best practice guidelines for nicotine dependence treatment, but is innovative in its use of a comprehensive wellness approach that addresses smoking within the context of HIV self-management including treatment adherence and engagement, stress management, substance use, and other personally relevant health behavior goals. The described randomized trial will enroll SLWH who are receiving care at Veterans Affairs (VA) medical centers and compare WISH's impact on smoking behavior to standard care services offered through the National VA Quitline and SmokefreeVET texting program. It will also assess intervention impact on markers of immune status and mortality risk. If effective, WISH could be disseminated to Veterans nationwide and could serve as a model for designing quitline interventions for other smokers who are ambivalent about quitting. The current paper outlines the rationale and methodology of the WISH trial, one of a series of studies recently funded by the National Cancer Institute to advance understanding of how to better promote smoking cessation among SLWH.
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Affiliation(s)
- Jennifer B McClure
- Kaiser Permanente Washington Health Research Institute, (formerly, Group Health Research Institute), 1730 Minor Ave, Suite 1600, Seattle, WA 98101, USA.
| | - Sheryl L Catz
- University of California, Davis, Betty Irene Moore School of Nursing, 4610 X St., Suite 4202, Sacramento, CA 95817, USA.
| | - Clementine Chalal
- Veterans Affairs Puget Sound Health Care System, Health Services Research and Development, Center of Innovation for Veteran-Centered and Value-Driven Care, 1660 S. Columbian Way, Seattle, WA 98108, USA.
| | - Ryan Ciuffetelli
- University of California, Davis, Betty Irene Moore School of Nursing, 4610 X St., Suite 4202, Sacramento, CA 95817, USA.
| | - Scott Coggeshall
- Veterans Affairs Puget Sound Health Care System, Health Services Research and Development, Center of Innovation for Veteran-Centered and Value-Driven Care, 1660 S. Columbian Way, Seattle, WA 98108, USA.
| | - Rian J DeFaccio
- Veterans Affairs Puget Sound Health Care System, Health Services Research and Development, Center of Innovation for Veteran-Centered and Value-Driven Care, 1660 S. Columbian Way, Seattle, WA 98108, USA.
| | - Sara Fleehart
- Veterans Affairs Puget Sound Health Care System, Health Services Research and Development, Center of Innovation for Veteran-Centered and Value-Driven Care, 1660 S. Columbian Way, Seattle, WA 98108, USA.
| | - Jaimee L Heffner
- Fred Hutchinson Cancer Research Center, Public Health Sciences Division, 1100 Fairview Ave N, M3-B232, PO Box 19024, Seattle, WA 98109, USA.
| | - Ella Thompson
- Kaiser Permanente Washington Health Research Institute, (formerly, Group Health Research Institute), 1730 Minor Ave, Suite 1600, Seattle, WA 98101, USA.
| | - Emily C Williams
- Veterans Affairs Puget Sound Health Care System, Health Services Research and Development, Center of Innovation for Veteran-Centered and Value-Driven Care, 1660 S. Columbian Way, Seattle, WA 98108, USA; University of Washington School of Public Health, Department of Health Services, 1959 NE Pacific Street, BOX 357660, Seattle, WA 98195, USA.
| | - Kristina Crothers
- Veterans Affairs Puget Sound Health Care System, Health Services Research and Development, Center of Innovation for Veteran-Centered and Value-Driven Care, 1660 S. Columbian Way, Seattle, WA 98108, USA; University of Washington School of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, Campus Box 356522, Seattle, WA 98195, USA.
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Antela A, Rivero A, Llibre JM, Moreno S. Redefining therapeutic success in HIV patients: an expert view. J Antimicrob Chemother 2021; 76:2501-2518. [PMID: 34077524 PMCID: PMC8446931 DOI: 10.1093/jac/dkab168] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Thanks to advances in the field over the years, HIV/AIDS has now become a manageable chronic condition. Nevertheless, a new set of HIV-associated complications has emerged, related in part to the accelerated ageing observed in people living with HIV/AIDS, the cumulative toxicities from exposure to antiretroviral drugs over decades and emerging comorbidities. As a result, HIV/AIDS can still have a negative impact on patients' quality of life (QoL). In this scenario, it is reasonable to believe that the concept of therapeutic success, traditionally associated with CD4 cell count restoration and HIV RNA plasma viral load suppression and the absence of drug resistances, needs to be redefined to include other factors that reach beyond antiretroviral efficacy. With this in mind, a group of experts initiated and coordinated the RET Project, and this group, using the available evidence and their clinical experience in the field, has proposed new criteria to redefine treatment success in HIV, arranged into five main concepts: rapid initiation, efficacy, simplicity, safety, and QoL. An extensive review of the literature was performed for each category, and results were discussed by a total of 32 clinicians with experience in HIV/AIDS (4 coordinators + 28 additional experts). This article summarizes the conclusions of these experts and presents the most updated overview on the five topics, along with a discussion of the experts' main concerns, conclusions and/or recommendations on the most controversial issues.
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Affiliation(s)
- Antonio Antela
- Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain
| | - Antonio Rivero
- Hospital Universitario Reina Sofía, Cordoba, Spain
- Universidad de Córdoba, Instituto Maimónides de Investigación Biomédica de Córdoba, Córdoba, Spain
| | - Josep M Llibre
- Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Santiago Moreno
- Hospital Universitario Ramón y Cajal, Universidad de Alcalá, IRYCIS, Madrid, Spain
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10
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Himelhoch S, Njie-Carr VPS, Peeples A, Awuah C, Federline A, Morton I. Evaluation of smoking cessation interventions for veterans in HIV clinics in the United States: a theory-informed concurrent mixed-method study. Health Psychol Behav Med 2021; 9:724-740. [PMID: 34484974 PMCID: PMC8409937 DOI: 10.1080/21642850.2021.1967159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Objective Although veterans living with HIV infection are burdened with smoking-related morbidities, few studies have explored theory-informed, evidence-based smoking cessation interventions in the Veterans Affairs (VA) Health System. Method In this concurrent mixed-method study, we sought to better understand factors influencing the adoption of existing evidence-based smoking cessation interventions (reminders, telephone quit lines, pharmacological) for veterans in VA HIV clinics. We explored the alignment of the revised Promoting Action on Research Implementation in Health Services Framework (i-PARIHS) with study results. Results Nineteen clinicians working at eight HIV clinics in the VA System participated in the study. Seven themes were identified with relative quantitative and qualitative data convergence of clinicians’ perceptions of the importance of integrating evidence-based smoking cessation interventions for veterans with HIV infection. Conclusion Identified themes underscore the need for clinicians to provide smoking cessation training, supportive care, and motivate veterans living with HIV infection to quit smoking. Integrating smoking cessation programs into HIV treatment plans in the veteran patient population is critical. Dedicated time to fully implement these efforts will maximize smoking cessation intervention efforts and will yield successful utilization and subsequent patient compliance. Importantly, combination strategies will ensure cessation program impact and sustainability. Trial registration:Netherlands National Trial Register identifier: ntr050..
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Affiliation(s)
- Seth Himelhoch
- College of Medicine, University of Kentucky, Lexington, USA
| | | | - Amanda Peeples
- Education and Clinical Center, U.S. Department of Veterans Affairs Maryland Health Care System, Mental Illness Research, Baltimore, Maryland, USA.,U.S. Department of Veterans Affairs Maryland Health Care System, Education and Academic Affairs, Baltimore, Maryland, USA
| | - Crystal Awuah
- School of Nursing, University of Maryland, Baltimore, Maryland, USA
| | - Amanda Federline
- U.S. Department of Veterans Affairs Maryland Health Care System, Education and Academic Affairs, Baltimore, Maryland, USA
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11
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Edwards JK, Cole SR, Breger TL, Rudolph JE, Filiatreau LM, Buchacz K, Humes E, Rebeiro PF, D'Souza G, Gill MJ, Silverberg MJ, Mathews WC, Horberg MA, Thorne J, Hall HI, Justice A, Marconi VC, Lima VD, Bosch RJ, Sterling TR, Althoff KN, Moore RD, Saag M, Eron JJ. Mortality Among Persons Entering HIV Care Compared With the General U.S. Population : An Observational Study. Ann Intern Med 2021; 174:1197-1206. [PMID: 34224262 PMCID: PMC8453103 DOI: 10.7326/m21-0065] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Understanding advances in the care and treatment of adults with HIV as well as remaining gaps requires comparing differences in mortality between persons entering care for HIV and the general population. OBJECTIVE To assess the extent to which mortality among persons entering HIV care in the United States is elevated over mortality among matched persons in the general U.S. population and trends in this difference over time. DESIGN Observational cohort study. SETTING Thirteen sites from the U.S. North American AIDS Cohort Collaboration on Research and Design. PARTICIPANTS 82 766 adults entering HIV clinical care between 1999 and 2017 and a subset of the U.S. population matched on calendar time, age, sex, race/ethnicity, and county using U.S. mortality and population data compiled by the National Center for Health Statistics. MEASUREMENTS Five-year all-cause mortality, estimated using the Kaplan-Meier estimator of the survival function. RESULTS Overall 5-year mortality among persons entering HIV care was 10.6%, and mortality among the matched U.S. population was 2.9%, for a difference of 7.7 (95% CI, 7.4 to 7.9) percentage points. This difference decreased over time, from 11.1 percentage points among those entering care between 1999 and 2004 to 2.7 percentage points among those entering care between 2011 and 2017. LIMITATION Matching on available covariates may have failed to account for differences in mortality that were due to sociodemographic factors rather than consequences of HIV infection and other modifiable factors. CONCLUSION Mortality among persons entering HIV care decreased dramatically between 1999 and 2017, although those entering care remained at modestly higher risk for death in the years after starting care than comparable persons in the general U.S. population. PRIMARY FUNDING SOURCE National Institutes of Health.
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Affiliation(s)
- Jessie K Edwards
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (J.K.E., S.R.C., T.L.B., L.M.F., J.J.E.)
| | - Stephen R Cole
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (J.K.E., S.R.C., T.L.B., L.M.F., J.J.E.)
| | - Tiffany L Breger
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (J.K.E., S.R.C., T.L.B., L.M.F., J.J.E.)
| | | | - Lindsey M Filiatreau
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (J.K.E., S.R.C., T.L.B., L.M.F., J.J.E.)
| | - Kate Buchacz
- Centers for Disease Control and Prevention, Atlanta, Georgia (K.B., H.I.H.)
| | - Elizabeth Humes
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (E.H., G.D., K.N.A.)
| | - Peter F Rebeiro
- Vanderbilt University School of Medicine, Nashville, Tennessee (P.F.R.)
| | - Gypsyamber D'Souza
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (E.H., G.D., K.N.A.)
| | - M John Gill
- University of Calgary, Calgary, Alberta, Canada (M.J.G.)
| | | | | | - Michael A Horberg
- Kaiser Permanente Mid-Atlantic Permanente Research Institute, Rockville, Maryland (M.A.H.)
| | - Jennifer Thorne
- Johns Hopkins University, Baltimore, Maryland (J.T., R.D.M.)
| | - H Irene Hall
- Centers for Disease Control and Prevention, Atlanta, Georgia (K.B., H.I.H.)
| | - Amy Justice
- Yale School of Public Health, New Haven, Connecticut, and Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut (A.J.)
| | | | - Viviane D Lima
- University of British Columbia, Vancouver, British Columbia, Canada (V.D.L.)
| | - Ronald J Bosch
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts (R.J.B.)
| | | | - Keri N Althoff
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (E.H., G.D., K.N.A.)
| | - Richard D Moore
- Johns Hopkins University, Baltimore, Maryland (J.T., R.D.M.)
| | - Michael Saag
- University of Alabama at Birmingham, Birmingham, Alabama (M.S.)
| | - Joseph J Eron
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (J.K.E., S.R.C., T.L.B., L.M.F., J.J.E.)
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12
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Peprah E, Armstrong-Hough M, Cook SH, Mukasa B, Taylor JY, Xu H, Chang L, Gyamfi J, Ryan N, Ojo T, Snyder A, Iwelunmor J, Ezechi O, Iyegbe C, O’Reilly P, Pascal Kengne A. An Emerging Syndemic of Smoking and Cardiopulmonary Diseases in People Living with HIV in Africa. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:3111. [PMID: 33803504 PMCID: PMC8003038 DOI: 10.3390/ijerph18063111] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 03/11/2021] [Accepted: 03/14/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND African countries have the highest number of people living with HIV (PWH). The continent is home to 12% of the global population, but accounts for 71% of PWH globally. Antiretroviral therapy has played an important role in the reduction of the morbidity and mortality rates for HIV, which necessitates increased surveillance of the threats from pernicious risks to which PWH who live longer remain exposed. This includes cardiopulmonary comorbidities, which pose significant public health and economic challenges. A significant contributor to the cardiopulmonary comorbidities is tobacco smoking. Indeed, globally, PWH have a 2-4-fold higher utilization of tobacco compared to the general population, leading to endothelial dysfunction and atherogenesis that result in cardiopulmonary diseases, such as chronic obstructive pulmonary disease and coronary artery disease. In the context of PWH, we discuss (1) the current trends in cigarette smoking and (2) the lack of geographically relevant data on the cardiopulmonary conditions associated with smoking; we then review (3) the current evidence on chronic inflammation induced by smoking and the potential pathways for cardiopulmonary disease and (4) the multifactorial nature of the syndemic of smoking, HIV, and cardiopulmonary diseases. This commentary calls for a major, multi-setting cohort study using a syndemics framework to assess cardiopulmonary disease outcomes among PWH who smoke. CONCLUSION We call for a parallel program of implementation research to promote the adoption of evidence-based interventions, which could improve health outcomes for PWH with cardiopulmonary diseases and address the health inequities experienced by PWH in African countries.
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Affiliation(s)
- Emmanuel Peprah
- School of Global Public Health, New York University, New York, NY 10012, USA; (M.A.-H.); (S.H.C.); (J.G.); (N.R.); (T.O.); (A.S.)
| | - Mari Armstrong-Hough
- School of Global Public Health, New York University, New York, NY 10012, USA; (M.A.-H.); (S.H.C.); (J.G.); (N.R.); (T.O.); (A.S.)
| | - Stephanie H. Cook
- School of Global Public Health, New York University, New York, NY 10012, USA; (M.A.-H.); (S.H.C.); (J.G.); (N.R.); (T.O.); (A.S.)
| | | | | | - Huichun Xu
- Division of Endocrinology, Diabetes and Nutrition, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA;
| | - Linda Chang
- Department of Neurology, University of Maryland School of Medicine, Baltimore, MD 21201, USA;
| | - Joyce Gyamfi
- School of Global Public Health, New York University, New York, NY 10012, USA; (M.A.-H.); (S.H.C.); (J.G.); (N.R.); (T.O.); (A.S.)
| | - Nessa Ryan
- School of Global Public Health, New York University, New York, NY 10012, USA; (M.A.-H.); (S.H.C.); (J.G.); (N.R.); (T.O.); (A.S.)
| | - Temitope Ojo
- School of Global Public Health, New York University, New York, NY 10012, USA; (M.A.-H.); (S.H.C.); (J.G.); (N.R.); (T.O.); (A.S.)
| | - Anya Snyder
- School of Global Public Health, New York University, New York, NY 10012, USA; (M.A.-H.); (S.H.C.); (J.G.); (N.R.); (T.O.); (A.S.)
| | - Juliet Iwelunmor
- College for Public Health and Social Justice, Saint Louis University, St. Louis, MO 63103, USA;
| | - Oliver Ezechi
- Nigerian Institute of Medical Research, Lagos, Nigeria;
| | - Conrad Iyegbe
- Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, New York, NY 10029, USA; (C.I.); (P.O.); (A.P.K.)
| | - Paul O’Reilly
- Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, New York, NY 10029, USA; (C.I.); (P.O.); (A.P.K.)
| | - Andre Pascal Kengne
- Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, New York, NY 10029, USA; (C.I.); (P.O.); (A.P.K.)
- South African Medical Research Council, Cape Town, South Africa
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13
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Sabin CA, Kunisaki KM, Bagkeris E, Post FA, Sachikonye M, Boffito M, Anderson J, Mallon P, Williams I, Vera JH, Johnson M, Babalis D, Winston A. Respiratory symptoms and chronic bronchitis in people with and without HIV infection. HIV Med 2020; 22:11-21. [PMID: 32892488 DOI: 10.1111/hiv.12955] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 06/29/2020] [Accepted: 08/05/2020] [Indexed: 12/29/2022]
Abstract
OBJECTIVES High rates of respiratory symptoms and chronic bronchitis (CB) are reported in people with HIV infection (PWH). We investigated the prevalence of respiratory symptoms and CB in PWH and HIV-negative people in the Pharmacokinetic and clinical Observations in PeoPle over fiftY (POPPY) study. METHODS Assessment of respiratory symptoms and CB was undertaken using the modified form of the St. George's Respiratory Questionnaire for chronic obstructive pulmonary disease (COPD). Univariate (χ2 tests, Mann-Whitney U tests and Spearman's rank correlation) and multivariable (linear and logistic regression) analyses were performed to consider associations of respiratory symptoms with demographic, lifestyle and HIV-related parameters, and with depressive symptoms and quality of life. RESULTS Among the 619 participants, respiratory Symptom scores were higher in older and younger PWH compared to older HIV-negative people, with median (interquartile range) scores of 17.7 (6.2, 39.5), 17.5 (0.9, 30.0) and 9.0 (0.9, 17.5), respectively (P = 0.0001); these differences remained significant after confounder adjustment. Sixty-three participants (10.2%) met the criteria for CB [44 (14.0%) older PWH, 14 (9.2%) younger PWH, and five (3.3%) older HIV-negative people; P = 0.002], with these differences also remaining after adjustment for confounding variables, particularly smoking status [older vs. younger PWH: odds ratio (OR) 4.48 (95% confidence interval (CI) 1.64, 12.30); P = 0.004; older PWH vs. HIV-negative people: OR 4.53 (95% CI 1.12, 18.28); P = 0.03]. Respiratory symptoms and CB were both associated with greater depressive symptom scores and poorer quality of life. No strong associations were reported between CB and immune function, HIV RNA or previous diagnosis of any AIDS event. CONCLUSIONS Respiratory symptoms and CB are more common in PWH than in demographically and lifestyle-similar HIV-negative people and are associated with poorer mental health and quality of life.
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Affiliation(s)
- C A Sabin
- Institute for Global Health, UCL, London, UK
| | - K M Kunisaki
- Minneapolis Veterans Affairs Health Care System, and University of Minnesota, Minneapolis, MN, USA
| | - E Bagkeris
- Institute for Global Health, UCL, London, UK
| | - F A Post
- Caldecot Centre, King's College Hospital, London, UK
| | - M Sachikonye
- UK Community Advisory Board (UK-CAB), London, UK
| | - M Boffito
- St. Stephen's Centre, Chelsea and Westminster Hospital, London, UK
| | - J Anderson
- Homerton University Hospital, London, UK
| | - Pwg Mallon
- HIV Molecular Research Group, School of Medicine, University College Dublin, Dublin, Ireland
| | - I Williams
- Institute for Global Health, UCL, London, UK
| | - J H Vera
- Elton John Centre, Brighton and Sussex University Hospital, Brighton, UK.,Department of Global Health and Infection, Brighton and Sussex Medical School, Brighton, UK
| | - M Johnson
- Ian Charleson Day Centre, Royal Free NHS Trust, London, UK
| | - D Babalis
- Imperial Clinical Trials Unit, Imperial College London, London, UK
| | - A Winston
- Department of Infectious Disease, Imperial College London, London, UK
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14
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Jiang C, Chen Q, Xie M. Smoking increases the risk of infectious diseases: A narrative review. Tob Induc Dis 2020; 18:60. [PMID: 32765200 PMCID: PMC7398598 DOI: 10.18332/tid/123845] [Citation(s) in RCA: 72] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Revised: 06/04/2020] [Accepted: 06/09/2020] [Indexed: 01/17/2023] Open
Abstract
Smoking is relevant to infectious diseases resulting in increased prevalence and mortality. In this article, we aim to provide an overview of the effects of smoking in various infections and to explain the potential mechanisms. We searched PubMed and other relevant databases for scientific studies that explored the relationship between smoking and infection. The mechanisms of susceptibility to infection in smokers may include alteration of the structural, functional and immunologic host defences. Smoking is one of the main risk factors for infections in the respiratory tract, digestive tract, reproductive tract, and other systems in humans, increasing the prevalence of HIV, tuberculosis, SARS-CoV, and the current SARS-CoV-2. Smoking cessation can reduce the risk of infection. Smoking increases the incidence of infections and aggravates the progress and prognosis of infectious diseases in a dose-dependent manner. Smoking cessation promotion and education are the most practical and economical preventive measures to reduce aggravation of disease infection owing to tobacco use.
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Affiliation(s)
- Chen Jiang
- Department of Gerontology and Respirology, Xiangya Hospital, Central South University, Changsha, China
| | - Qiong Chen
- National Clinical Research Centre for Geriatric Disorders, Department of Geriatrics, Xiangya Hospital, Central South University, Changsha, China
| | - Mingxuan Xie
- Department of Gerontology and Respirology, Xiangya Hospital, Central South University, Changsha, China
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15
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Haque S, Kodidela S, Sinha N, Kumar P, Cory TJ, Kumar S. Differential packaging of inflammatory cytokines/ chemokines and oxidative stress modulators in U937 and U1 macrophages-derived extracellular vesicles upon exposure to tobacco constituents. PLoS One 2020; 15:e0233054. [PMID: 32433651 PMCID: PMC7239484 DOI: 10.1371/journal.pone.0233054] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 04/27/2020] [Indexed: 12/19/2022] Open
Abstract
Smoking, which is highly prevalent in HIV-infected populations, has been shown to exacerbate HIV replication, in part via the cytochrome P450 (CYP)-induced oxidative stress pathway. Recently, we have shown that extracellular vesicles (EVs), derived from tobacco- and/or HIV-exposed macrophages, alter HIV replication in macrophages by cell-cell interactions. We hypothesize that cigarette smoke condensate (CSC) and/or HIV-exposed macrophage-derived EVs carry relatively high levels of pro-oxidant and pro-inflammatory cargos and/or low levels of antioxidant and anti-inflammatory cargos, which are key mediators for HIV pathogenesis. Therefore, in this study, we investigated differential packaging of pro- and anti-inflammatory cytokines/chemokines and pro- and anti-oxidant contents in EVs after CSC exposure to myeloid cells (uninfected U937 and HIV-infected U1 cells). Our results showed that relatively long to short exposures with CSC increased the expression of cytokines in EVs isolated from HIV-infected U1 macrophages. Importantly, pro-inflammatory cytokines, especially IL-6, were highly packaged in EVs isolated from HIV-infected U1 macrophages upon both long and short-term CSC exposures. In general, anti-inflammatory cytokines, particularly IL-10, had a lower packaging in EVs, while packaging of chemokines was mostly increased in EVs upon CSC exposure in both HIV-infected U1 and uninfected U937 macrophages. Moreover, we observed higher expression of CYPs (1A1 and 1B1) and lower expression of antioxidant enzymes (SOD-1 and catalase) in EVs from HIV-infected U1 macrophages than in uninfected U937 macrophages. Together, they are expected to increase oxidative stress factors in EVs derived from HIV-infected U1 cells. Taken together, our results suggest packaging of increased level of oxidative stress and inflammatory elements in the EVs upon exposure to tobacco constituents and/or HIV to myeloid cells, which would ultimately enhance HIV replication in macrophages via cell-cell interactions.
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Affiliation(s)
- Sanjana Haque
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Tennessee Health Science Center, Memphis, TN, United States of America
| | - Sunitha Kodidela
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Tennessee Health Science Center, Memphis, TN, United States of America
| | - Namita Sinha
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Tennessee Health Science Center, Memphis, TN, United States of America
| | - Prashant Kumar
- Division of Pediatric Nephrology, Le Bonheur Children's Hospital, University of Tennessee Health Science Center, Memphis, TN, United States of America
| | - Theodore J. Cory
- Department of Clinical Pharmacy and Translational Sciences, College of Pharmacy, University of Tennessee Health Science Center, Memphis, TN, United States of America
| | - Santosh Kumar
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Tennessee Health Science Center, Memphis, TN, United States of America
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16
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Vinci C. Cognitive Behavioral and Mindfulness-Based Interventions for Smoking Cessation: a Review of the Recent Literature. Curr Oncol Rep 2020; 22:58. [PMID: 32415381 PMCID: PMC7874528 DOI: 10.1007/s11912-020-00915-w] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE OF REVIEW Cigarette smoking is the primary cause of cancer and is the leading preventable cause of morbidity and mortality. Cognitive behavioral therapy (CBT) is one of the most well-established and efficacious interventions for smoking cessation. The study of mindfulness-based interventions (MBIs) has increased exponentially in recent years, showing efficacy for smoking cessation as well. This review highlights research from the past 5 years examining CBT and MBIs for smoking cessation. RECENT FINDINGS Both CBT and MBIs are efficacious for special populations (e.g., low SES; pregnant smokers) and have shown initial efficacy when delivered via mhealth/ehealth. CBT has shown efficacy when combined with another behavioral treatment (e.g., ACT). Continued research is needed on CBT and MBIs that have high potential for scalability. Understanding whether they are beneficial for certain populations (e.g., cancer survivors), along with determining for whom CBT vs MBIs are most effective, is also needed.
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Affiliation(s)
- Christine Vinci
- Moffitt Cancer Center, Health Outcomes and Behavior, 4115 E Fowler Ave, Tampa, FL, 33617, USA.
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17
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Mutemwa M, Peer N, de Villiers A, Faber M, Kengne AP. Tobacco smoking and associated factors in human immunodeficiency virus-infected adults attending human immunodeficiency virus clinics in the Western Cape province, South Africa. South Afr J HIV Med 2020; 21:1072. [PMID: 32391178 PMCID: PMC7203270 DOI: 10.4102/sajhivmed.v21i1.1072] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 02/14/2020] [Indexed: 12/16/2022] Open
Abstract
Background In human immunodeficiency virus (HIV)-infected individuals, smoking increases both HIV-related and non-related negative health outcomes. Objectives To determine the prevalence and associations of smoking in HIV-infected adults receiving antiretroviral therapy at public healthcare facilities in the Western Cape province, South Africa. Methods Participants comprised 827 HIV-infected patients, who were > 18 years old and randomly selected from 17 HIV healthcare facilities. Self-reported smoking was defined as smoking tobacco daily or occasionally. Serum cotinine levels confirmed smoking status. Results Participants included 653 women and 174 men. The overall mean (standard deviation [SD]) age was 38.9 (9.0) years, 41.1 (8.9) years in men and 37.7 (8.9) years in women (p ˂ 0.001). The median diagnosed duration of HIV infection was 5 years. Smoking prevalence was 22% overall, and 26% in men and 21% in women (p = 0.022). The prevalence of former smoking was 14%. About a quarter of participants (185/751; 24.6%) had serum cotinine levels > 100 mg/mL with similar prevalence of high levels across smoking status (current smokers: 27.2%, former smokers: 29.6% and never smokers: 22.7%, p = 0.564) and did not vary by age, gender, cluster of differentiation 4 count or known duration of HIV. There was no agreement between self-reports and cotinine levels at ranking smoking exposure. Conclusions Prevalence of current tobacco smoking in HIV-infected patients on care is within the range of that in the general population. This highlights the potential missed opportunity or challenges of co-addressing smoking cessation in individuals already in regular contact with the health system.
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Affiliation(s)
- Muyunda Mutemwa
- Non-Communicable Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Nasheeta Peer
- Non-Communicable Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa.,Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Anniza de Villiers
- Research Capacity Development Division, South African Medical Research Council, Cape Town, South Africa
| | - Mieke Faber
- Non-Communicable Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Andre-Pascal Kengne
- Non-Communicable Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa.,Department of Medicine, University of Cape Town, Cape Town, South Africa
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18
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Affiliation(s)
- Julia Kastner
- University of Maryland School of Medicine, Baltimore, MD
| | - Rydhwana Hossain
- University of Maryland School of Medicine, Cardiothoracic Imaging, Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland Medical Center, Baltimore, MD
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19
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Sigel K, Park L, Justice A. HIV and cancer in the Veterans Health Administration System. Semin Oncol 2019; 46:334-340. [PMID: 31703932 DOI: 10.1053/j.seminoncol.2019.09.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 09/25/2019] [Indexed: 12/18/2022]
Abstract
Cancer is a leading cause of death for people with HIV (PWH). The Veterans Healthcare System (VA) is the largest single institutional provider of HIV care in the United States. Cancer among Veterans with HIV is major issue and clinical research has expanded significantly during the antiretroviral therapy (ART) era providing numerous insights regarding cancer incidence, risk factors, prevention, treatment and outcomes for this unique group of patients. This work has been greatly facilitated by the availability of national VA data sources. Notably, patterns of cancer incidence have changed for Veterans with HIV during the ART era; non-AIDS defining malignancies now are the most common tumors. Despite better HIV control in the ART era, immunosuppression measured by low CD4 counts and HIV viremia have been associated with increased cancer risk. Cancer outcomes for Veterans with HIV may now be similar to uninfected Veterans, but information on outcomes and cancer treatment patterns remains limited, requiring further study to help inform prevention and treatment strategies.
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Affiliation(s)
- Keith Sigel
- Icahn School of Medicine at Mount Sinai, NY, NY.
| | - Lesley Park
- Stanford University School of Medicine, Palo Alto, CA
| | - Amy Justice
- VA Connecticut Healthcare System, West Haven, CT; Yale University School of Medicine
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Zifodya JS, Crothers K. Treating bacterial pneumonia in people living with HIV. Expert Rev Respir Med 2019; 13:771-786. [PMID: 31241378 DOI: 10.1080/17476348.2019.1634546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Introduction: Bacterial pneumonia remains an important cause of morbidity and mortality in people living with HIV (PLWH) in the antiretroviral therapy (ART) era. In addition to being immunocompromised, as reflected by low CD4 cell counts and elevated HIV viral loads, PLWH often have other behaviors associated with an increased risk of pneumonia including smoking and injected drug use. As PLWH are aging, comorbid conditions such as chronic obstructive pulmonary disease (COPD), cancers, and cardiovascular, renal and liver diseases are emerging as additional risk factors for pneumonia. Pathogens are often similar to those in HIV-uninfected individuals; however, PLWH are at risk for unusual and/or multi-drug resistant organisms causing bacterial pneumonia based, in part, on their CD4 cell counts and other exposures. Areas covered: In this review, we focus on the recognition and management of bacterial community-acquired pneumonia (CAP) in PLWH. Along with antimicrobial treatment, we discuss prevention strategies such as vaccination and smoking cessation. Expert opinion: Early initiation of ART after HIV infection can decrease the risk of pneumonia. Improved efforts at vaccination, smoking cessation, and reduction of other substance use are urgently needed in PLWH to decrease the risk for bacterial pneumonia. As PLWH are aging, comorbidities are additional risk factors for bacterial CAP.
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Affiliation(s)
- Jerry S Zifodya
- a Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington , Seattle , Washington , USA
| | - Kristina Crothers
- a Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington , Seattle , Washington , USA
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Labbe AK, Wilner JG, Coleman JN, Marquez SM, Kosiba JD, Zvolensky MJ, Smits JAJ, Norton PJ, Rosenfield D, O'Cleirigh C. A qualitative study of the feasibility and acceptability of a smoking cessation program for people living with HIV and emotional dysregulation. AIDS Care 2019; 31:609-615. [PMID: 30350712 PMCID: PMC6408255 DOI: 10.1080/09540121.2018.1533225] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Accepted: 09/27/2018] [Indexed: 12/15/2022]
Abstract
Despite high rates of co-occurring tobacco use and anxiety among persons living with HIV, evidence-based interventions for these individuals are limited. An existing cognitive-behavioral treatment protocol for smoking cessation and anxiety (Norton, P. J., & Barrera, T. L. (2012). Transdiagnostic versus diagnosis-specific CBT for anxiety disorders: A preliminary randomized controlled noninferiority trial. Depression and Anxiety, 29(10), 874-882. https://doi.org/10.1002/da.21974) was modified to address transdiagnostic constructs, such as anxiety sensitivity, distress tolerance, and depressive symptomatology (Labbe, A. K., Wilner, J. G., Kosiba, J. D., Gonzalez, A., Smits, J. A., Zvolensky, M. J., … O'Cleirigh, C. (2017). Demonstration of an Integrated Treatment for Smoking Cessation and Anxiety Symptoms in People with HIV: A Clinical Case Study. Cognitive and Behavioral Practice, 24(2), 200-214. https://doi.org/10.1016/j.cbpra.2016.03.009). This study examines the feasibility and acceptability of the intervention as determined from qualitative data from structured exit interviews from 10 participants who completed treatment. Results demonstrated that participants were very motivated to quit smoking and enrolled in the program for health-related reasons and to be able to quit. Participants found nearly all the treatment components to be useful for reaching their smoking cessation goal and in managing emotional dysregulation. Last, all participants stated that they would strongly recommend the treatment program. This qualitative study provides initial evidence for the feasibility and acceptability of a modified smoking cessation treatment protocol for HIV+ individuals with anxiety and emotional dysregulation. Future research will focus on evaluating the efficacy of the protocol in a full-scale randomized controlled trial, as well as working to collect qualitative data from participants who discontinue treatment to better understand reasons for treatment attrition.
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Affiliation(s)
- A K Labbe
- a Dept. of Psychiatry , Massachusetts General Hospital , Boston , MA , USA
| | - J G Wilner
- b Dept. of Psychology , Boston University , Boston , MA , USA
| | - J N Coleman
- c Dept. of Psychology , Duke University , Raleigh , NC , USA
| | - S M Marquez
- d The Fenway Institute , Fenway Health , Boston , MA , USA
| | - J D Kosiba
- e Dept. of Psychology , Syracuse University , Syracuse , NY , USA
| | - M J Zvolensky
- f Dept. of Psychology , University of Houston , Houston , TX , USA
| | - J A J Smits
- g Dept. of Psychology , University of Texas at Austin , Austin , TX , USA
| | - P J Norton
- f Dept. of Psychology , University of Houston , Houston , TX , USA
| | - D Rosenfield
- h Dept. of Psychology , Southern Methodist University , Dallas , TX , USA
| | - C O'Cleirigh
- a Dept. of Psychiatry , Massachusetts General Hospital , Boston , MA , USA
- d The Fenway Institute , Fenway Health , Boston , MA , USA
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Matthews AK, Breen E, Veluz-Wilkins A, Ciecierski C, Simon M, Burrell D, Hitsman B. Adaptation of a Proactive Smoking Cessation Intervention to Increase Tobacco Quitline Use by LGBT Smokers. Prog Community Health Partnersh 2019; 13:71-84. [PMID: 31378737 PMCID: PMC6980318 DOI: 10.1353/cpr.2019.0040] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE The study purpose was to evaluate the content of a proactive population health management intervention aimed at promoting uptake of smoking cessation treatments offered by the Illinois Tobacco Quitline (ITQL) among lesbian, gay, bisexual, and transgender (LGBT)-identified smokers. METHODS This study represents a partnership between a community-based health center and university researchers. As part of the study, focus groups and in-depth interviews were conducted with LGBT smokers (N = 30). First, we conducted focus groups to obtain feedback on the readability, acceptability, and motivational salience of a targeted and nontargeteed proactive outreach letter. After revisions, a series of in-depth interviews were conducted to evaluate finalized materials. Focus groups and interviews were systematically analyzed. RESULTS Based on feedback, the revised intervention letter was rated more positively than the initial version, with 80% of participants indicating that they found the information in the letter to be useful. Further, more participants reported that the letter would motivate them to accept a call from a quitline counselor compared with the initial version (47.6% vs. 60.0%, respectively). In the final iteration, 60% of participants preferred the targeted letter, 30% preferred the non-targeted letter, and 10% had no preference. In the first iteration, outreach text messages were rated as unacceptable or completely unacceptable by 54% of participants. The revised text messages and protocols were seen as unacceptable by only 10% of participants. CONCLUSIONS The development and testing of population-based and cost-effective interventions is critical to the reduction of LGBT smoking disparities. The study protocol and intervention materials were well-received by participants. In a future study, we will evaluate the efficacy of the intervention in increasing use of the quitline among LGBT smokers.
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Mitton JA, North CM, Muyanja D, Okello S, Vořechovská D, Kakuhikire B, Tsai AC, Siedner MJ. Smoking cessation after engagement in HIV care in rural Uganda. AIDS Care 2018; 30:1622-1629. [PMID: 29879856 PMCID: PMC6258063 DOI: 10.1080/09540121.2018.1484070] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
People living with HIV (PLWH) are more likely to smoke compared to HIV-uninfected counterparts, but little is known about smoking behaviors in sub-Saharan Africa. To address this gap in knowledge, we characterized smoking cessation patterns among people living with HIV (PLWH) compared to HIV-uninfected individuals in rural Uganda. PLWH were at least 40 years of age and on antiretroviral therapy for at least three years, and HIV-uninfected individuals were recruited from the clinical catchment area. Our primary outcome of interest was smoking cessation, which was assessed using an adapted WHO STEPS smoking questionnaire. We fit Cox proportional hazards models to compare time to smoking cessation between PLWH pre-care, PLWH in care, and HIV-uninfected individuals. We found that, compared to HIV-uninfected individuals, PLWH in care were less likely to have ever smoked (40% vs. 49%, p = 0.04). The combined sample of 267 ever-smokers had a median age of 56 (IQR 49-68), 56% (n = 150) were male, and 26% (n = 70) were current smokers. In time-to-event analyses, HIV-uninfected individuals and PLWH prior to clinic enrollment ceased smoking at similar rates (HR 0.8, 95% CI 0.5-1.2). However, after enrolling in HIV care, PLWH had a hazard of smoking cessation over twice that of HIV-uninfected individuals and three times that of PLWH prior to enrollment (HR 2.4, 95% CI 1.3-4.6, p = 0.005 and HR 3.0, 95% CI 1.6-5.5, p = 0.001, respectively). In summary, we observed high rates of smoking cessation among PLWH after engagement in HIV care in rural Uganda. While we hypothesize that greater access to primary care services and health counseling might contribute, future studies should better investigate the mechanism of this association.
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Affiliation(s)
- Julian A. Mitton
- Department of Medicine, Massachusetts General Hospital, Boston, USA
- Department of Medicine, Harvard Medical School, Boston, USA
| | - Crystal M. North
- Department of Medicine, Massachusetts General Hospital, Boston, USA
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, USA
| | - Daniel Muyanja
- Department of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Samson Okello
- Department of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, USA
- Department of Medicine, University of Virginia, Charlottesville, USA
| | - Dagmar Vořechovská
- Department of Global Health, Massachusetts General Hospital, Boston, USA
| | - Bernard Kakuhikire
- Institute of Management Sciences, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Alexander C. Tsai
- Department of Global Health, Massachusetts General Hospital, Boston, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, USA
- Department of Psychiatry, Harvard Medical School, Boston, USA
| | - Mark J. Siedner
- Department of Medicine, Massachusetts General Hospital, Boston, USA
- Department of Medicine, Harvard Medical School, Boston, USA
- Department of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
- Department of Global Health, Massachusetts General Hospital, Boston, USA
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OʼCleirigh C, Zvolensky MJ, Smits JAJ, Labbe AK, Coleman JN, Wilner JG, Stanton AM, Gonzalez A, Garey L, Regenauer KS, Rosenfield D. Integrated Treatment for Smoking Cessation, Anxiety, and Depressed Mood in People Living With HIV: A Randomized Controlled Trial. J Acquir Immune Defic Syndr 2018; 79:261-268. [PMID: 30212438 PMCID: PMC10041790 DOI: 10.1097/qai.0000000000001787] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Among people living with HIV, cigarette smoking rates are higher than among the general population, and anxiety, depression, and their disorders are common and associated with smoking and poorer outcomes during cessation. This study evaluated the efficacy of an integrated smoking cessation intervention, developed to target anxiety, depression, and smoking cessation concurrently among people living with HIV. METHOD Smokers living with HIV who reported at least moderate motivation to quit smoking were randomized into a novel 9-week integrated intervention (QUIT), consisting of 1 psychoeducation (prerandomization) session and 9 weekly 1-hour sessions of cognitive behavioral therapy for smoking cessation and anxiety/depression plus nicotine replacement therapy, or a 9-week enhanced standard smoking intervention (ETAU), consisting of 1 psychoeducation session (prerandomization) and 4 brief weekly check-in sessions plus nicotine replacement therapy. All were instructed to make a quit attempt at week 6. RESULTS Seventy-two participants were enrolled, and 53 were randomized. 41/53 participants completed the active treatment phase of the study. 7-day point-prevalence abstinence, verified with expired carbon monoxide, was significantly higher among those in the integrated intervention than those in the enhanced standard intervention both end-of-treatment {[MQUIT = 59%, METAU = 9%; b = 5.60, 95% confidence interval: (2.64 to 8.56), t(332) = 3.72, P < 0.001]} and 6-months post-quit date {[MQUIT = 46%, METAU = 5%; b = 7.69, 95% confidence interval: (4.60 to 10.78), t(332) = 4.90, P < 0.001]}. Consideration of patterns of missingness did not alter the significance of these findings. CONCLUSIONS The integrated intervention was associated with substantially higher short-term and long-term abstinence rates than the enhanced standard intervention. These data provide promising initial evidence supporting the benefits of an integrated anxiety-depression/smoking cessation program specifically tailored for people living with HIV.
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Affiliation(s)
- Conall OʼCleirigh
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Michael J Zvolensky
- Department of Psychology, University of Houston, Houston, TX
- Department of Behavioral Sciences, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jasper A J Smits
- Department of Psychology, University of Texas at Austin, Austin, TX
| | - Allison K Labbe
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Jessica N Coleman
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA
- Department of Psychology & Neuroscience, Duke University, Durham, NC
| | - Julianne G Wilner
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA
- Department of Psychological & Brain Sciences, Boston University, Boston, MA
| | - Amelia M Stanton
- Department of Psychology, University of Texas at Austin, Austin, TX
| | - Adam Gonzalez
- Department of Psychiatry, SUNY Stony Brook School of Medicine, Stony Brook, NY
| | - Lorra Garey
- Department of Psychology, University of Houston, Houston, TX
| | | | - David Rosenfield
- Department of Psychology, Southern Methodist University, Dallas, TX
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Benefits and harms of lung cancer screening in HIV-infected individuals with CD4+ cell count at least 500 cells/μl. AIDS 2018; 32:1333-1342. [PMID: 29683843 PMCID: PMC5991188 DOI: 10.1097/qad.0000000000001818] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Lung cancer is the leading cause of non-AIDS-defining cancer deaths among HIV-infected individuals. Although lung cancer screening with low-dose computed tomography (LDCT) is endorsed by multiple national organizations, whether HIV-infected individuals would have similar benefit as uninfected individuals from lung cancer screening is unknown. Our objective was to determine the benefits and harms of lung cancer screening among HIV-infected individuals. DESIGN We modified an existing simulation model, the Lung Cancer Policy Model, for HIV-infected patients. DATA SOURCES Veterans Aging Cohort Study, Kaiser Permanente Northern California HIV Cohort, and medical literature. TARGET POPULATION HIV-infected current and former smokers. TIME HORIZON Lifetime. PERSPECTIVE Population. INTERVENTION Annual LDCT screening from ages 45, 50, or 55 until ages 72 or 77 years. MAIN OUTCOME MEASURES Benefits assessed included lung cancer mortality reduction and life-years gained; harms assessed included numbers of LDCT examinations, false-positive results, and overdiagnosed cases. RESULTS OF BASE-CASE ANALYSIS For HIV-infected patients with CD4 cell count at least 500 cells/μl and 100% antiretroviral therapy adherence, screening using the Centers for Medicare & Medicaid Services criteria (age 55-77, 30 pack-years of smoking, current smoker or quit within 15 years of screening) would reduce lung cancer mortality by 18.9%, similar to the mortality reduction of uninfected individuals. Alternative screening strategies utilizing lower screening age and/or pack-years criteria increase mortality reduction, but require more LDCT examinations. LIMITATIONS Strategies assumed 100% screening adherence. CONCLUSION Lung cancer screening reduces mortality in HIV-infected patients with CD4 cell count at least 500 cells/μl, with a number of efficient strategies for eligibility, including the current Centers for Medicare & Medicaid Services criteria.
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Trickey A, May MT, Davies C, Qureshi H, Hamid S, Mahmood H, Saeed Q, Hickman M, Glass N, Averhoff F, Vickerman P. Importance and Contribution of Community, Social, and Healthcare Risk Factors for Hepatitis C Infection in Pakistan. Am J Trop Med Hyg 2017; 97:1920-1928. [PMID: 29141707 DOI: 10.4269/ajtmh.17-0019] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Pakistan has a high prevalence of hepatitis C virus (HCV) infection, estimated at 4.9% (2,290/46,843) in the 2007 national HCV seroprevalence survey. We used data from this survey to assess the importance of risk factor associations with HCV prevalence in Pakistan. Exposures were grouped as community (going to the barbers, sharing smoking equipment, having an ear/nose piercing, tattoo, or acupuncture), healthcare (ever having hemodialysis, blood transfusion, or ≥ 5 injections in the last year), demographic (marital status and age), and socio-economic (illiterate or laborer). We used mutually adjusted multivariable regression analysis, stratified by sex, to determine associations with HCV infection, their population attributable fraction, and how risk of infection accumulates with multiple exposures. Strength of associations was assessed using adjusted odds ratios (aOR). Community [aOR females 1.5 (95% confidence interval [CI]: 1.2, 1.8); males 1.2 (1.1, 1.4)] and healthcare [females 1.4 (1.2, 1.6); males 1.2 (1.1, 1.4)] exposures, low socio-economic status [females 1.6 (1.3, 1.80); males 1.3 (1.2, 1.5)], and marriage [females 1.5 (1.2, 1.9); males 1.4 (1.1, 1.8)] were associated with increased HCV infection. Among married women, the number of children was associated with an increase in HCV infection; linear trend aOR per child 1.06 (1.01, 1.11). Fewer infections could be attributed to healthcare exposures (females 13%; males 6%) than to community exposures (females 25%; males 9%). Prevalence increased from 3% to 10% when cumulative exposures increased from 1 to ≥ 4 [aOR per additional exposure for females 1.5 (1.4, 1.6); males 1.2 (1.2, 1.3)]. A combination of community, healthcare, and other factors appear to drive the Pakistan HCV epidemic, highlighting the need for a comprehensive array of prevention strategies.
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Affiliation(s)
- Adam Trickey
- Bristol Medical School, University of Bristol, Bristol, United Kingdom.,National Institute of Health Research (NIHR) Health Protection Research Unit (HPRU) in Evaluation of Interventions, Bristol, United Kingdom
| | - Margaret T May
- National Institute of Health Research (NIHR) Health Protection Research Unit (HPRU) in Evaluation of Interventions, Bristol, United Kingdom.,Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Charlotte Davies
- Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Huma Qureshi
- Pakistan Medical Research Council (PMRC), Islamabad, Pakistan
| | - Saeed Hamid
- Department of Medicine, Aga Khan University, Karachi, Pakistan
| | - Hassan Mahmood
- Pakistan Medical Research Council (PMRC), Islamabad, Pakistan
| | - Quaid Saeed
- National AIDS Control Programme, Islamabad, Pakistan
| | - Matthew Hickman
- National Institute of Health Research (NIHR) Health Protection Research Unit (HPRU) in Evaluation of Interventions, Bristol, United Kingdom.,Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Nancy Glass
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Peter Vickerman
- National Institute of Health Research (NIHR) Health Protection Research Unit (HPRU) in Evaluation of Interventions, Bristol, United Kingdom.,Bristol Medical School, University of Bristol, Bristol, United Kingdom
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Abstract
PURPOSE OF REVIEW In the era of effective antiretroviral therapy, HIV-positive patients experience an increase in non-AIDS associated comorbidities. Causes of death are now more frequently associated with ageing and smoking; alcohol and drug use are strongly linked to many of these causes. RECENT FINDINGS An almost equal life expectancy among HIV-positive people compared with HIV-negative population has been recently reported. However, life expectancy is reduced among HIV-positive smokers by at least 16 years and further reduced for people who have a history of excessive alcohol and drug use. Cohort studies report between a 1.5- and two-fold or greater increased mortality risk as a result of smoking. In a Danish population study, 61% of deaths in HIV-positive people were associated with smoking. Excessive alcohol and drug use are also elevated among specific HIV subpopulations and significantly impact morbidity and mortality. In the Veteran Affairs cohort study, moderate and excessive alcohol use increased mortality by 25-35% compared with low alcohol use. SUMMARY Despite the effective therapy, smoking, alcohol and drug use have a significant role in increased mortality and reduced life expectancy among HIV-positive people. These factors need to be in continued focus for the management and care of HIV-positive people.
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28
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Do TC, Boettiger D, Law M, Pujari S, Zhang F, Chaiwarith R, Kiertiburanakul S, Lee MP, Ditangco R, Wong WW, Nguyen KV, Merati TP, Pham TT, Kamarulzaman A, Oka S, Yunihastuti E, Kumarasamy N, Kantipong P, Choi JY, Ng OT, Durier N, Ruxrungtham K. Smoking and projected cardiovascular risk in an HIV-positive Asian regional cohort. HIV Med 2017; 17:542-9. [PMID: 27430354 DOI: 10.1111/hiv.12358] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2015] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The aim of the study was to assess the prevalence and characteristics associated with current smoking in an Asian HIV-positive cohort, to calculate the predictive risks of cardiovascular disease (CVD), coronary heart disease (CHD) and myocardial infarction (MI), and to identify the impact that simulated interventions may have. METHODS Logistic regression analysis was used to distinguish associated current smoking characteristics. Five-year predictive risks of CVD, CHD and MI and the impact of simulated interventions were calculated utilizing the Data Collection on Adverse Effects of Anti-HIV Drugs Study (D:A:D) algorithm. RESULTS Smoking status data were collected from 4274 participants and 1496 of these had sufficient data for simulated intervention calculations. Current smoking prevalence in these two groups was similar (23.2% vs. 19.9%, respectively). Characteristics associated with current smoking included age > 50 years compared with 30-39 years [odds ratio (OR) 0.65; 95% confidence interval (CI) 0.51-0.83], HIV exposure through injecting drug use compared with heterosexual exposure (OR 3.03; 95% CI 2.25-4.07), and receiving antiretroviral therapy (ART) at study sites in Singapore, South Korea, Malaysia, Japan and Vietnam in comparison to Thailand (all OR > 2). Women were less likely to smoke than men (OR 0.11; 95% CI 0.08-0.14). In simulated interventions, smoking cessation demonstrated the greatest impact in reducing CVD and CHD risk and closely approximated the impact of switching from abacavir to an alternate antiretroviral in the reduction of 5-year MI risk. CONCLUSIONS Multiple interventions could reduce CVD, CHD and MI risk in Asian HIV-positive patients, with smoking cessation potentially being the most influential.
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Affiliation(s)
- T C Do
- HIVNAT/Thai Red Cross AIDS Research Center, Bangkok, Thailand
| | - D Boettiger
- The Kirby Institute, UNSW Australia, Sydney, Australia
| | - M Law
- The Kirby Institute, UNSW Australia, Sydney, Australia
| | - S Pujari
- Institute of Infectious Diseases, Pune, India
| | - F Zhang
- Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - R Chaiwarith
- Research Institute for Health Sciences, Chiang Mai, Thailand
| | - S Kiertiburanakul
- Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - M P Lee
- Queen Elizabeth Hospital, Hong Kong, China
| | - R Ditangco
- Research Institute for Tropical Medicine, Manila, Philippines
| | - W W Wong
- Taipei Veterans General Hospital, Taipei, Taiwan
| | - K V Nguyen
- National Hospital for Tropical Diseases, Hanoi, Vietnam
| | - T P Merati
- Faculty of Medicine Udayana University & Sanglah Hospital, Bali, Indonesia
| | - T T Pham
- Bach Mai Hospital, Hanoi, Vietnam
| | - A Kamarulzaman
- University Malaya Medical Center, Kuala Lumpur, Malaysia
| | - S Oka
- AIDS Clinical Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - E Yunihastuti
- Working Group on AIDS Faculty of Medicine, University of Indonesia/Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - N Kumarasamy
- Chennai Antiviral Research and Treatment Clinical Research Site (CART CRS), YRGCARE Medical Centre, VHS, Chennai, India
| | - P Kantipong
- Chiangrai Prachanukroh Hospital, Chiang Rai, Thailand
| | - J Y Choi
- Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - O T Ng
- Tan Tock Seng Hospital, Singapore
| | - N Durier
- TREAT Asia, amfAR - The Foundation for AIDS Research, Bangkok, Thailand
| | - K Ruxrungtham
- HIVNAT/Thai Red Cross AIDS Research Center, Bangkok, Thailand.,Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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Van Schayck OCP, Williams S, Barchilon V, Baxter N, Jawad M, Katsaounou PA, Kirenga BJ, Panaitescu C, Tsiligianni IG, Zwar N, Ostrem A. Treating tobacco dependence: guidance for primary care on life-saving interventions. Position statement of the IPCRG. NPJ Prim Care Respir Med 2017; 27:38. [PMID: 28600490 PMCID: PMC5466643 DOI: 10.1038/s41533-017-0039-5] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Revised: 03/29/2017] [Accepted: 05/09/2017] [Indexed: 11/12/2022] Open
Abstract
Tobacco smoking is the world's leading cause of premature death and disability. Global targets to reduce premature deaths by 25% by 2025 will require a substantial increase in the number of smokers making a quit attempt, and a significant improvement in the success rates of those attempts in low, middle and high income countries. In many countries the only place where the majority of smokers can access support to quit is primary care. There is strong evidence of cost-effective interventions in primary care yet many opportunities to put these into practice are missed. This paper revises the approach proposed by the International Primary Care Respiratory Group published in 2008 in this journal to reflect important new evidence and the global variation in primary-care experience and knowledge of smoking cessation. Specific for primary care, that advocates for a holistic, bio-psycho-social approach to most problems, the starting point is to approach tobacco dependence as an eminently treatable condition. We offer a hierarchy of interventions depending on time and available resources. We present an equitable approach to behavioural and drug interventions. This includes an update to the evidence on behaviour change, gender difference, comparative information on numbers needed to treat, drug safety and availability of drugs, including the relatively cheap drug cytisine, and a summary of new approaches such as harm reduction. This paper also extends the guidance on special populations such as people with long-term conditions including tuberculosis, human immunodeficiency virus, cardiovascular disease and respiratory disease, pregnant women, children and adolescents, and people with serious mental illness. We use expert clinical opinion where the research evidence is insufficient or inconclusive. The paper describes trends in the use of waterpipes and cannabis smoking and offers guidance to primary-care clinicians on what to do faced with uncertain evidence. Throughout, it recognises that clinical decisions should be tailored to the individual's circumstances and attitudes and be influenced by the availability and affordability of drugs and specialist services. Finally it argues that the role of the International Primary Care Respiratory Group is to improve the confidence as well as the competence of primary care and, therefore, makes recommendations about clinical education and evaluation. We also advocate for an update to the WHO Model List of Essential Medicines to optimise each primary-care intervention. This International Primary Care Respiratory Group statement has been endorsed by the Member Organisations of World Organization of Family Doctors Europe.
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Affiliation(s)
- O C P Van Schayck
- Department of Family Medicine, CAPHRI, Maastricht University, Maastricht, The Netherlands.
| | - S Williams
- International Primary Care Respiratory Group, Aberdeen, UK
| | - V Barchilon
- Andalusian Health Service (SAS), Tobacco group of GRAP (Primary Care Respiratory Group), Andalusia, Spain
| | - N Baxter
- International Primary Care Respiratory Group, Aberdeen, UK
- Southwark Clinical Commissioning Group, London, UK
| | - M Jawad
- Faculty of Medicine, School of Public Health, Imperial College London, London, UK
| | - P A Katsaounou
- Pulmonary Medicine, Medical School, National and Kapodistran University of Athens, Evaggelismos Hospital, Athens, Greece
| | - B J Kirenga
- Lung Institute and Division of Pulmonary Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - C Panaitescu
- Family Medicine Solo Practice, RespiRo- Romanian Primary Care Respiratory Group, Bucharest, Romania
| | - I G Tsiligianni
- Clinic of Social and Family Medicine, Faculty of Medicine, University of Crete, Crete, Greece
| | - N Zwar
- School of Public Health and Community Medicine, UNSW Australia, Sydney, NSW, Australia
| | - A Ostrem
- General Practitioner, Gransdalen Legesenter, Oslo, Norway
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Topographies of Cortical and Subcortical Volume Loss in HIV and Aging in the cART Era. J Acquir Immune Defic Syndr 2017; 73:374-383. [PMID: 27454251 DOI: 10.1097/qai.0000000000001111] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVES Studies of HIV-associated brain atrophy often focus on a priori brain regions of interest, which can introduce bias. A data-driven, minimally biased approach was used to analyze changes in brain volumetrics associated with HIV and their relationship to aging, viral factors, combination antiretroviral therapy (cART), and gender, and smoking. DESIGN A cross-sectional study of 51 HIV-uninfected (HIV-) and 146 HIV-infected (HIV+) participants. METHODS Structural MRI of participants was analyzed using principal component analysis (PCA) to reduce dimensionality and determine topographies of volumetric changes. Neuropsychological (NP) assessment was examined using global and domain-specific scores. The effects of HIV disease factors (eg, viral load, CD4, etc.) on brain volumes and neuropsychological were investigated using penalized regression (LASSO). RESULTS Two components of interest were visualized using principal component analysis. An aging effect predominated for both components. The first component, a cortically weighted topography, accounted for a majority of variance across participants (43.5% of variance) and showed independent effects of HIV and smoking. A secondary, subcortically weighted topography (4.6%) showed HIV-status accentuated age-related volume loss. In HIV+ patients, the cortical topography correlated with global neuropsychological scores and nadir CD4, whereas subcortical volume loss was associated with recent viral load. CONCLUSIONS Cortical regions showed the most prominent volumetric changes because of aging and HIV. Within HIV+ participants, cortical volumes were associated with immune history, whereas subcortical changes correlated with current immune function. Cognitive function was primarily associated with cortical volume changes. Observed volumetric changes in chronic HIV+ patients may reflect both past infection history and current viral status.
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Behavioral Interventions for Tobacco Use in HIV-Infected Smokers: A Meta-Analysis. J Acquir Immune Defic Syndr 2017; 72:527-33. [PMID: 27028502 DOI: 10.1097/qai.0000000000001007] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
CONTEXT Smoking is responsible for increased morbidity and mortality in HIV-infected smokers. OBJECTIVE To assess the efficacy of behavioral interventions for smoking cessation among HIV-infected smokers compared with the standard care. DATA SOURCES PubMed, Cochrane, CINHAL, PsychINFO, and Google Scholar were searched for randomized controlled trials published in English. STUDY SELECTION Eligibility criteria were randomized controlled trials with targeted behavioral interventions compared with standard of care (or enhanced standard of care) aimed at promoting abstinence in HIV-infected smokers. A total of 17,384 articles were found and 17,371 were excluded; 13 full text articles were obtained and reviewed, and 8 met the eligibility criteria (Κ = 0.94). DATA EXTRACTION The primary outcome was expired carbon monoxide-verified 7-day point prevalence abstinence rates. Adequate sequence generation and freedom from incomplete or selective outcome reporting was used to assess study quality. RESULTS A total of 1822 subjects from 8 studies yielded a statistically significant effect of behavioral interventions in increasing abstinence in HIV-infected smokers with a moderate effect size (relative risk: 1.51; 95% confidence interval: 1.17 to 1.95). Those studies with interventions of 8 sessions or more had a large effect size for abstinence (relative risk: 2.88; 95% confidence interval: 1.89 to 4.61). When stratified by the number of sessions, there was no heterogeneity. CONCLUSIONS Targeted behavioral smoking cessation interventions are efficacious. Interventions consisting of 8 sessions or more had the greatest treatment efficacy.
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Levy ME, Greenberg AE, Hart R, Powers Happ L, Hadigan C, Castel A. High burden of metabolic comorbidities in a citywide cohort of HIV outpatients: evolving health care needs of people aging with HIV in Washington, DC. HIV Med 2017; 18:724-735. [PMID: 28503912 DOI: 10.1111/hiv.12516] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2017] [Indexed: 12/23/2022]
Abstract
OBJECTIVES With the increasing impact of cardiovascular disease among populations aging with HIV, contemporary prevalence estimates for predisposing metabolic comorbidities will be important for guiding the provision of relevant lifestyle and pharmacological interventions. We estimated the citywide prevalence of hypertension, type 2 diabetes, dyslipidaemia, and obesity; examined differences by demographic subgroups; and assessed clinical correlates. METHODS Utilizing an electronic medical record (EMR) database from the DC Cohort study - a multicentre prospective cohort study of HIV-infected outpatients - we assessed the period prevalence of metabolic comorbidities between 2011 and 2015 using composite definitions that incorporated diagnoses, pharmacy records, and clinical/laboratory results. RESULTS Of 7018 adult patients (median age 50 years; 77% black), 50% [95% confidence interval (CI) 49-51] had hypertension, 13% (95% CI: 12-14) had diabetes, 48% (95% CI: 47-49) had dyslipidaemia, and 35% (95% CI: 34-36) had obesity. Hypertension was more prevalent among black patients, diabetes and obesity were more prevalent among female and black patients, dyslipidaemia was more prevalent among male and white patients, and comorbidities were more prevalent among older patients (all P < 0.001). For many patients, evidence of treatment for these comorbidities was not available in the EMR. Longer time since HIV diagnosis, greater duration of antiretroviral treatment, and having controlled immunovirological parameters were associated with metabolic comorbidities. CONCLUSIONS These findings underscore the pervasive burden of metabolic comorbidities among HIV-infected persons, serve as the basis for future analyses characterizing their impact on subsequent adverse cardiovascular outcomes, and highlight the need for an increased focus on the prevention and control of comorbid complications in this population.
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Affiliation(s)
- M E Levy
- Department of Epidemiology and Biostatistics, Milken Institute School of Public Health at the George Washington University, Washington, DC, USA
| | - A E Greenberg
- Department of Epidemiology and Biostatistics, Milken Institute School of Public Health at the George Washington University, Washington, DC, USA
| | - R Hart
- Research Department, Cerner Corporation, Kansas City, MO, USA
| | - L Powers Happ
- Department of Epidemiology and Biostatistics, Milken Institute School of Public Health at the George Washington University, Washington, DC, USA
| | - C Hadigan
- Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - A Castel
- Department of Epidemiology and Biostatistics, Milken Institute School of Public Health at the George Washington University, Washington, DC, USA
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Demonstration of an Integrated Treatment for Smoking Cessation and Anxiety Symptoms in People With HIV: A Clinical Case Study. COGNITIVE AND BEHAVIORAL PRACTICE 2017. [DOI: 10.1016/j.cbpra.2016.03.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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34
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Immediate Smoking Cessation Among People Living with HIV. ARCHIVES OF CLINICAL INFECTIOUS DISEASES 2017. [DOI: 10.5812/archcid.62765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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35
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Presti RM, Flores SC, Palmer BE, Atkinson JJ, Lesko CR, Lau B, Fontenot AP, Roman J, McDyer JF, Twigg HL. Mechanisms Underlying HIV-Associated Noninfectious Lung Disease. Chest 2017; 152:1053-1060. [PMID: 28427967 DOI: 10.1016/j.chest.2017.04.154] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Revised: 02/28/2017] [Accepted: 04/05/2017] [Indexed: 01/15/2023] Open
Abstract
Pulmonary disease remains a primary source of morbidity and mortality in persons living with HIV (PLWH), although the advent of potent combination antiretroviral therapy has resulted in a shift from predominantly infectious to noninfectious pulmonary complications. PLWH are at high risk for COPD, pulmonary hypertension, and lung cancer even in the era of combination antiretroviral therapy. The underlying mechanisms of this are incompletely understood, but recent research in both human and animal models suggests that oxidative stress, expression of matrix metalloproteinases, and genetic instability may result in lung damage, which predisposes PLWH to these conditions. Some of the factors that drive these processes include tobacco and other substance use, direct HIV infection and expression of specific HIV proteins, inflammation, and shifts in the microbiome toward pathogenic and opportunistic organisms. Further studies are needed to understand the relative importance of these factors to the development of lung disease in PLWH.
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Affiliation(s)
- Rachel M Presti
- Department of Medicine, Washington University School of Medicine, St. Louis, MO.
| | - Sonia C Flores
- Department of Medicine, University of Colorado Denver, Aurora, CO
| | - Brent E Palmer
- Department of Medicine, University of Colorado Denver, Aurora, CO
| | - Jeffrey J Atkinson
- Department of Medicine, Washington University School of Medicine, St. Louis, MO
| | - Catherine R Lesko
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, School of Medicine, Johns Hopkins University, Baltimore, MD
| | - Bryan Lau
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, School of Medicine, Johns Hopkins University, Baltimore, MD
| | | | - Jesse Roman
- Department of Medicine, University of Louisville, Health Sciences Center and Robley Rex VA Medical Center, Louisville, KY
| | - John F McDyer
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Homer L Twigg
- Department of Medicine, Indiana University, Indianapolis, IN
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Weldehaweria NB, Abreha EH, Weldu MG, Misgina KH. Psychosocial correlates of nutritional status among people living with HIV on antiretroviral therapy: A matched case-control study in Central zone of Tigray, Northern Ethiopia. PLoS One 2017; 12:e0174082. [PMID: 28301592 PMCID: PMC5354448 DOI: 10.1371/journal.pone.0174082] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Accepted: 03/03/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Malnutrition hastens progression to Acquired Human Immunodeficiency Syndromes (AIDS) related illnesses; undermines adherence and response to antiretroviral therapy (ART) in resource-poor settings. However, nutritional status of people living with HIV (PLHIV) can be affected by various psychosocial factors which have not been well explored in Ethiopia. Therefore, the objective of this study was to determine psychosocial correlates of nutritional status among people living with HIV (PLHIV) on ART in Central zone of Tigray, Northern Ethiopia. METHODS A matched case-control study design was conducted to assess psychosocial correlates of nutritional status among PLHIV on ART. Data were collected by an interviewer-administered technique using structured pre-tested questionnaire, record review using a checklist and anthropometric measurements. Cases were selected by simple random sampling and controls purposively to match the selected cases. Conditional logistic regression was used to compute relevant associations by STATA version 12. RESULTS The psychosocial factors independently associated with malnutrition were ever consuming alcohol after starting ART [AOR = 4.7, 95% CI: 1.8-12.3], ever smoking cigarette after starting ART [AOR = 7.6, 95% CI: 2.3-25.5], depression [AOR = 2.8, 95% CI: 1.3, 6.1], not adhering to ART [AOR = 6.8,95% CI: 2.0-23.0] and being in the second lowest wealth quintile [AOR = 4.3,95% CI: 1.1-17.7]. CONCLUSION Ever consuming alcohol and ever smoking cigarette after starting ART, depression, not adhering to ART and being in the second lowest wealth quintile were significantly associated with malnutrition. Therefore; policies, strategies, and programs targeting people living with HIV should consider psychosocial factors that can impact nutritional status of people living with HIV enrolled on ART.
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Affiliation(s)
| | - Elsa Hagos Abreha
- Department of Biomedical Sciences, College of Health Sciences, Semara University, Semara, Afar, Ethiopia
| | - Meresa Gebremedhin Weldu
- Department of Public Health, College of Health Sciences, Aksum University, Aksum, Tigray, Ethiopia
| | - Kebede Haile Misgina
- Department of Public Health, College of Health Sciences, Aksum University, Aksum, Tigray, Ethiopia
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Abstract
PURPOSE OF REVIEW Lung cancer is emerging as a leading cause of death in HIV-infected persons. This review will discuss the latest scientific evidence regarding the mechanisms driving lung cancer risk in HIV infection, the clinical presentation of lung cancer in HIV-infected persons and recent data regarding the outcomes, treatment and prevention of lung cancer in this group. RECENT FINDINGS Increased risk of lung cancer in HIV-infected persons is primarily due to higher smoking rates, but emerging evidence also implicates immunosuppression and inflammatory processes. Lung cancer outcomes may be worse in HIV-infected persons in the antiretroviral era, but this may stem, in part, from treatment disparities. Early detection of lung cancer using chest computed tomography (CT) is being increasingly adopted for smokers in the general population, and recent studies suggest that it may be safe and efficacious in HIV-infected smokers. SUMMARY Lung cancer is an important complication associated with chronic HIV infection. It is associated with unique HIV-related causal mechanisms, and may be associated with worse outcomes in some HIV-infected persons. Smoking cessation and early cancer detection with chest CT are likely to benefit HIV-infected smokers.
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Affiliation(s)
- Keith Sigel
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, NY, NY
| | - Alain Makinson
- Department of Infectious and Tropical Diseases, U1175-INSERM/UMI 233, IRD, University Montpellier, Montpellier
| | - Jonathan Thaler
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, NY, NY
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Mwiru RS, Nagu TJ, Kaduri P, Mugusi F, Fawzi W. Prevalence and patterns of cigarette smoking among patients co-infected with human immunodeficiency virus and tuberculosis in Tanzania. Drug Alcohol Depend 2017; 170:128-132. [PMID: 27889593 DOI: 10.1016/j.drugalcdep.2016.11.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Revised: 11/01/2016] [Accepted: 11/08/2016] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Cigarette smoking is one of the major risk factors for non-AIDS related morbidities and is highly prevalent among HIV infected people. However, no reports exist from Tanzania, one of the countries highly affected by the HIV pandemic and one of Africa's biggest tobacco producer. METHODS We examined the patterns and prevalence of cigarette smoking among HIV and TB co-infected adult patients in Dar es Salaam using a cross sectional study design. Proportions were used to describe the pattern of cigarette smoking. Logistic regression was used to assess the association of various participant characteristics with smoking. RESULTS Out of the 518 participants, 17 (3.3%) were current smokers, 96 (18.5%) were ex-smokers and the rest (78.2%) denied ever smoking. Male sex (p<0.001), alcohol (p<0.001), and illicit substance use (p<0.001) were significantly associated with cigarette smoking. CONCLUSIONS The study indicates that, the level of current cigarette smoking among HIV/TB co-infected patients in Dar es Salaam is low. Nevertheless, the preponderance of cigarette smoking among men, alcohol drinkers, and those who use illicit substances provides a unique opportunity for targeting such population with smoking cessation interventions; HIV care and treatment clinics are uniquely positioned to provide such interventions.
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Affiliation(s)
| | - Tumaini Joseph Nagu
- Department of Internal Medicine, Muhimbili University of Health and Allied Sciences, United Nations Rd, P.O. Box 65001, Dar es Salaam, Tanzania; Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden.
| | - Pamela Kaduri
- Department of Psychiatry and Mental Health, Muhimbili National Hospital, Kalenga Street, Upanga West, P.O. Box 65000, Dar es Salaam, Tanzania.
| | - Ferdinand Mugusi
- Department of Internal Medicine, Muhimbili University of Health and Allied Sciences, United Nations Rd, P.O. Box 65001, Dar es Salaam, Tanzania.
| | - Wafaie Fawzi
- Departments of Global Health and Population, Nutrition and Epidemiology, Harvard T.H. Chan School of Public Health,665 Huntington Avenue, Boston, MA, USA.
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Reddy KP, Parker RA, Losina E, Baggett TP, Paltiel AD, Rigotti NA, Weinstein MC, Freedberg KA, Walensky RP. Impact of Cigarette Smoking and Smoking Cessation on Life Expectancy Among People With HIV: A US-Based Modeling Study. J Infect Dis 2016; 214:1672-1681. [PMID: 27815384 DOI: 10.1093/infdis/jiw430] [Citation(s) in RCA: 83] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Accepted: 08/03/2016] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND In the United States, >40% of people infected with human immunodeficiency virus (HIV) smoke cigarettes. METHODS We used a computer simulation of HIV disease and treatment to project the life expectancy of HIV-infected persons, based on smoking status. We used age- and sex-specific data on mortality, stratified by smoking status. The ratio of the non-AIDS-related mortality risk for current smokers versus that for never smokers was 2.8, and the ratio for former smokers versus never smokers was 1.0-1.8, depending on cessation age. Projected survival was based on smoking status, sex, and initial age. We also estimated the total potential life-years gained if a proportion of the approximately 248 000 HIV-infected US smokers quit smoking. RESULTS Men and women entering HIV care at age 40 years (mean CD4+ T-cell count, 360 cells/µL) who continued to smoke lost 6.7 years and 6.3 years of life expectancy, respectively, compared with never smokers; those who quit smoking upon entering care regained 5.7 years and 4.6 years, respectively. Factors associated with greater benefits from smoking cessation included younger age, higher initial CD4+ T-cell count, and complete adherence to antiretroviral therapy. Smoking cessation by 10%-25% of HIV-infected smokers could save approximately 106 000-265 000 years of life. CONCLUSIONS HIV-infected US smokers aged 40 years lose >6 years of life expectancy from smoking, possibly outweighing the loss from HIV infection itself. Smoking cessation should become a priority in HIV treatment programs.
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Affiliation(s)
- Krishna P Reddy
- Medical Practice Evaluation Center.,Division of Pulmonary and Critical Care Medicine.,Harvard Medical School
| | - Robert A Parker
- Medical Practice Evaluation Center.,Division of General Internal Medicine.,Biostatistics Center.,Harvard Medical School
| | - Elena Losina
- Medical Practice Evaluation Center.,Harvard Medical School.,Department of Orthopedic Surgery.,Department of Biostatistics
| | - Travis P Baggett
- Division of General Internal Medicine.,Harvard Medical School.,Boston Health Care for the Homeless Program
| | | | - Nancy A Rigotti
- Division of General Internal Medicine.,Tobacco Research and Treatment Center.,Mongan Institute for Health Policy.,Harvard Medical School
| | - Milton C Weinstein
- Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Kenneth A Freedberg
- Medical Practice Evaluation Center.,Division of General Internal Medicine.,Division of Infectious Diseases, Massachusetts General Hospital.,Harvard Medical School.,Department of Epidemiology, Boston University School of Public Health.,Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Rochelle P Walensky
- Medical Practice Evaluation Center.,Division of General Internal Medicine.,Division of Infectious Diseases, Massachusetts General Hospital.,Harvard Medical School.,Division of Infectious Diseases, Brigham and Women's Hospital
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Williams EC, Hahn JA, Saitz R, Bryant K, Lira MC, Samet JH. Alcohol Use and Human Immunodeficiency Virus (HIV) Infection: Current Knowledge, Implications, and Future Directions. Alcohol Clin Exp Res 2016; 40:2056-2072. [PMID: 27696523 PMCID: PMC5119641 DOI: 10.1111/acer.13204] [Citation(s) in RCA: 202] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Accepted: 07/28/2016] [Indexed: 12/20/2022]
Abstract
Alcohol use is common among people living with human immunodeficiency virus (HIV). In this narrative review, we describe literature regarding alcohol's impact on transmission, care, coinfections, and comorbidities that are common among people living with HIV (PLWH), as well as literature regarding interventions to address alcohol use and its influences among PLWH. This narrative review identifies alcohol use as a risk factor for HIV transmission, as well as a factor impacting the clinical manifestations and management of HIV. Alcohol use appears to have additive and potentially synergistic effects on common HIV-related comorbidities. We find that interventions to modify drinking and improve HIV-related risks and outcomes have had limited success to date, and we recommend research in several areas. Consistent with Office of AIDS Research/National Institutes of Health priorities, we suggest research to better understand how and at what levels alcohol influences comorbid conditions among PLWH, to elucidate the mechanisms by which alcohol use is impacting comorbidities, and to understand whether decreases in alcohol use improve HIV-relevant outcomes. This should include studies regarding whether state-of-the-art medications used to treat common coinfections are safe for PLWH who drink alcohol. We recommend that future research among PLWH include validated self-report measures of alcohol use and/or biological measurements, ideally both. Additionally, subgroup variation in associations should be identified to ensure that the risks of particularly vulnerable populations are understood. This body of research should serve as a foundation for a next generation of intervention studies to address alcohol use from transmission to treatment of HIV. Intervention studies should inform implementation efforts to improve provision of alcohol-related interventions and treatments for PLWH in healthcare settings. By making further progress on understanding how alcohol use affects PLWH in the era of HIV as a chronic condition, this research should inform how we can mitigate transmission, achieve viral suppression, and avoid exacerbating common comorbidities of HIV and alcohol use and make progress toward the 90-90-90 goals for engagement in the HIV treatment cascade.
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Affiliation(s)
- Emily C Williams
- Veterans Health Administration (VA) Health Services Research and Development, Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle, Washington.,Department of Health Services, University of Washington, Seattle, Washington
| | - Judith A Hahn
- Departments of Medicine and Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California
| | - Richard Saitz
- Department of Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts.,Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts
| | - Kendall Bryant
- Consortiums for HIV/AIDS and Alcohol Research Translation (CHAART) National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, Maryland
| | - Marlene C Lira
- Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts
| | - Jeffrey H Samet
- Department of Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts. .,Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts.
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Akhtar-Khaleel WZ, Cook RL, Shoptaw S, Surkan PJ, Teplin LA, Stall R, Beyth RJ, Manini TM, Plankey M. Long-Term Cigarette Smoking Trajectories Among HIV-Seropositive and Seronegative MSM in the Multicenter AIDS Cohort Study. AIDS Behav 2016; 20:1713-21. [PMID: 26922718 DOI: 10.1007/s10461-016-1343-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
To examine the association between demographic characteristics and long-term smoking trajectory group membership among HIV-seropositive and HIV-seronegative men who have sex with men (MSM). A cohort of 6552 MSM from the Multicenter AIDS Cohort Study were asked detailed information about their smoking history since their last follow-up. Group-based trajectory modeling was used to examine smoking behavior and identify trajectory group membership. Because participants enrolled after 2001 were more likely to be younger, HIV-seronegative, non-Hispanic black, and have a high school diploma or less, we also assessed time of enrollment in our analysis. Participants were grouped into 4 distinct smoking trajectory groups: persistent nonsmoker (n = 3737 [55.9 %]), persistent light smoker (n = 663 [11.0 %]), heavy smoker to nonsmoker (n = 531 [10.0 %]), and persistent heavy smoker (n = 1604 [23.1 %]). Compared with persistent nonsmokers, persistent heavy smokers were associated with being enrolled in 2001 and later (adjusted odds ratio [aOR] 2.35; 95 % CI 2.12-2.58), having a high school diploma or less (aOR 3.22; 95 % CI 3.05-3.39), and being HIV-seropositive (aOR 1.17; 95 % CI 1.01-1.34). These associations were statistically significant across all trajectory groups for time of enrollment and education but not for HIV serostatus. The overall decrease of smoking as shown by our trajectory groups is consistent with the national trend. Characteristics associated with smoking group trajectory membership should be considered in the development of targeted smoking cessation interventions among MSM and people living with HIV.
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Affiliation(s)
- Wajiha Z Akhtar-Khaleel
- Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, PO Box 100231, Gainesville, FL, 32610, USA.
| | - Robert L Cook
- Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, PO Box 100231, Gainesville, FL, 32610, USA
| | - Steve Shoptaw
- Departments of Family Medicine and Psychiatry, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Pamela J Surkan
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Linda A Teplin
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Ronald Stall
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Rebecca J Beyth
- Malcom Randall VA Medical Center, Gainesville, FL, USA
- Department of Medicine, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Todd M Manini
- Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, PO Box 100231, Gainesville, FL, 32610, USA
- Department of Aging & Geriatric Research, Institute on Aging, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Michael Plankey
- Department of Medicine, Division of Infectious Diseases, Georgetown University Medical Center, Washington, DC, USA
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Baghaei P, Esmaeili S, Farshidpour M, Javanmard P, Marjani M, Moniri A, Nemati K, Tabarsi P. Diagnosing active and latent tuberculosis among Iranian HIV-infected patients. CLINICAL RESPIRATORY JOURNAL 2016; 12:62-67. [PMID: 27059900 DOI: 10.1111/crj.12479] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Revised: 02/06/2016] [Accepted: 03/31/2016] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To screen for Tuberculosis (TB) in human immunodeficiency virus (HIV) people in an effort to improve early TB diagnosis and reduce TB transmission. METHODS A prospective study was conducted on adult HIV people from 2008 to 2011. Three samples of sputum, cell blood count, tuberculin skin test (TST) and chest X-ray were obtained from all patients. The characteristics of HIV patients with TB and HIV patients without TB were compared to each other. RESULTS Of the 154 HIV patients included, 58 (38%) had tuberculosis with a mean CD4 cell count of 68 cells/mm3 . Active TB was found in 56 (47%) patients with a history of intravenous drug use. Cough (OR = 3.1, 95% CI 1.2-7.79), positive TST (OR = 8.15, 95% CI 3.28-20.25) and an abnormal chest X-ray (OR = 5.1, 95% CI 1.84-14.2) were the predicting factors for detecting active TB among HIV patients. The sensitivity and specificity of a combination of any symptoms with chest X-ray, smear, TST or all of these were 96.5% and 86.5%, respectively. CD4 cell count <100 (OR = 2.67; 95% CI 1.23-5.78) and smoking (OR = 13.4; 95% CI 3.04-59.4) remained independently associated with TB in a multivariate analysis. CONCLUSION There was a high prevalence of TB within the HIV population. Screening for TB among these patients can be carried out at every clinic or health facility using a combination of symptoms, TST, chest X-ray and smear sample.
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Affiliation(s)
- Parvaneh Baghaei
- Clinical Tuberculosis and Epidemiology Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Masih Daneshvari Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Shahrbanou Esmaeili
- Clinical Tuberculosis and Epidemiology Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Masih Daneshvari Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Maham Farshidpour
- Clinical Tuberculosis and Epidemiology Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Masih Daneshvari Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Pedram Javanmard
- Department of Internal Medicine, SUNY Stony Brook University, Stony Brook, NY, USA
| | - Majid Marjani
- Clinical Tuberculosis and Epidemiology Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Masih Daneshvari Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Afshin Moniri
- Clinical Tuberculosis and Epidemiology Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Masih Daneshvari Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Kambiz Nemati
- Clinical Tuberculosis and Epidemiology Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Masih Daneshvari Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Payam Tabarsi
- Clinical Tuberculosis and Epidemiology Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Masih Daneshvari Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Abstract
Pulmonary malignancies are a major source of morbidity and mortality in HIV-infected persons. Non-AIDS-defining lung cancers (mostly non-small cell lung cancers) are now a leading cause of cancer death among HIV-infected persons. HIV-associated factors appear to affect the risk of lung cancer and may adversely impact cancer treatment and outcomes. HIV infection also may modify the potential harms and benefits of lung cancer screening with computed tomography. AIDS-defining lung malignancies include pulmonary Kaposi sarcoma and pulmonary lymphoma, both of which are less prevalent with widespread adoption of antiretroviral therapy.
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Affiliation(s)
- Keith Sigel
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Robert Pitts
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
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44
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Akhtar-Khaleel WZ, Cook RL, Shoptaw S, Surkan P, Stall R, Beyth RJ, Teplin LA, Plankey M. Trends and Predictors of Cigarette Smoking Among HIV Seropositive and Seronegative Men: The Multicenter Aids Cohort Study. AIDS Behav 2016; 20:622-32. [PMID: 26093780 DOI: 10.1007/s10461-015-1099-6] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
We measured the trend of cigarette smoking among HIV-seropositive and seronegative men over time from 1984 to 2012. Additionally, we examined the demographic correlates of smoking and smoking consumption. Six thousand and five hundred and seventy seven men who have sex with men (MSM) from the Multicenter AIDS Cohort Study (MACS) were asked detailed information about their smoking history since their visit. Prevalence of smoking and quantity smoked was calculated yearly from 1984 to 2012. Poisson regression with robust error variance was used to estimate prevalence ratios of smoking in univariate and multivariate models. In 2012, 11.8 and 36.9 % of men who were enrolled in the MACS before 2001 or during or after 2001 smoked cigarettes, respectively. In the multivariate analysis, black, non-Hispanic, lower education, enrollment wave, alcohol use, and marijuana use were positively associated with current smoking in MSM. HIV serostatus was not significant in the multivariate analysis. However, HIV variables, such as detectable viral load, were positively associated. Though cigarette smoking has declined over time, the prevalence still remains high among subgroups. There is still a need for tailored smoking cessation programs to decrease the risk of smoking in HIV-seropositive MSM.
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Affiliation(s)
- Wajiha Z Akhtar-Khaleel
- Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, PO Box 100231, Gainesville, FL, 32610, USA.
- Department of Health, HIV/AIDS, Hepatitis, STD, and TB Administration, Washington, DC, USA.
| | - Robert L Cook
- Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, PO Box 100231, Gainesville, FL, 32610, USA
| | - Steven Shoptaw
- David Geffen School of Medicine, Departments of Family Medicine and Psychiatry, University of California, Los Angeles, Los Angeles, CA, USA
| | - Pamela Surkan
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Ronald Stall
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Rebecca J Beyth
- Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, PO Box 100231, Gainesville, FL, 32610, USA
- Malcom Randall VA Medical Center, Gainesville, FL, USA
| | - Linda A Teplin
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Michael Plankey
- Division of Infectious Diseases, Department of Medicine, Georgetown University Medical Center, Washington, DC, USA
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45
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Kariuki W, Manuel JI, Kariuki N, Tuchman E, O'Neal J, Lalanne GA. HIV and smoking: associated risks and prevention strategies. HIV AIDS-RESEARCH AND PALLIATIVE CARE 2015; 8:17-36. [PMID: 26766919 PMCID: PMC4700813 DOI: 10.2147/hiv.s56952] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
High rates of smoking among persons living with HIV (PLWH) may reduce the effectiveness of HIV treatment and contribute to significant morbidity and mortality. Factors associated with smoking in PLWH include mental health comorbidity, alcohol and drug use, health-related quality of life, smoking among social networks and supports, and lack of access to care. PLWH smokers are at a higher risk of numerous HIV-associated infections and non-HIV related morbidity, including a decreased response to antiretroviral treatment, impaired immune functioning, reduced cognitive functioning, decreased lung functioning, and cardiovascular disease. Seventeen smoking cessation interventions were identified, of which seven were randomized controlled trials. The most effective studies combined behavioral and pharmacotherapy treatments that incorporated comprehensive assessments, multiple sessions, and cognitive-behavioral and motivational strategies. Smoking cessation interventions that are tailored to the unique needs of diverse samples and incorporate strategies to reduce the risk of relapse are essential to advancing health outcomes in PLWH.
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Affiliation(s)
- Wanjiku Kariuki
- University of Texas School of Public Health, Department of Management, Policy, and Community Health, Houston, TX, USA
| | | | - Ngaruiya Kariuki
- Internal Medicine Department, Maimonides Medical Center, Brooklyn, USA
| | - Ellen Tuchman
- Silver School of Social Work, New York University, New York, USA
| | - Johnnie O'Neal
- Department of Social Work, The College of New Rochelle, New Rochelle, NY, USA
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46
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Skalski LM, Watt MH, MacFarlane JC, Proeschold-Bell RJ, Stout JE, Sikkema KJ. Mental Health and Substance Use Among Patients in a North Carolina HIV Clinic. N C Med J 2015; 76:148-55. [PMID: 26510216 DOI: 10.18043/ncm.76.3.148] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND The HIV/AIDS epidemic is a significant public health concern in North Carolina, and previous research has pointed to elevated mental health distress and substance use among HIV-infected populations, which may impact patients' adherence to medications. The aims of this study were to describe the prevalence of mental health and substance use issues among patients of a North Carolina HIV clinic, to examine differences by demographic characteristics, and to examine factors associated with suboptimal adherence to HIV medications. METHODS This study was a secondary analysis of clinical data routinely collected through a health behavior questionnaire at a large HIV clinic in North Carolina. We analyzed data collected from February 2011 to August 2012. RESULTS The sample included 1,398 patients. Overall, 12.2% of patients endorsed current symptomology indicative of moderate or severe levels of depression, and 38.6% reported receiving a psychiatric diagnosis at some point in their life. Additionally, 19.1% had indications of current problematic drinking, and 8.2% reported problematic drug use. Nearly one-quarter (22.1%) reported suboptimal adherence to HIV medications. Factors associated with poor adherence included racial/ethnic minority, age less than 35 years, and indications of moderate or severe depression. LIMITATIONS The questionnaire was not completed systematically in the clinic, which may limit generalizability, and self-reported measures may have introduced social desirability bias. CONCLUSION Patients were willing to disclose mental health distress, substance use, and suboptimal medication adherence to providers, which highlights the importance of routinely assessing these behaviors during clinic visits. Our findings suggest that treating depression may be an effective strategy to improve adherence to HIV medications.
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Affiliation(s)
- Linda M Skalski
- doctoral student, Department of Psychology and Neuroscience, Duke University, Durham, North Carolina
| | - Melissa H Watt
- assistant research professor, Duke Global Health Institute, Duke University, Durham, North Carolina
| | - Jessica C MacFarlane
- research assistant, Duke Global Health Institute, Duke University, Durham, North Carolina
| | - Rae Jean Proeschold-Bell
- assistant research professor, Duke Global Health Institute and Center for Health Policy & Inequalities Research, Duke University, Durham, North Carolina
| | - Jason E Stout
- associate professor of medicine, Department of Medicine, Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina
| | - Kathleen J Sikkema
- professor, Department of Psychology and Neuroscience, Duke University; professor, Global Health Institute, Duke University; director, social and behavioral sciences, Duke Center for AIDS Research, Duke University; director of clinical psychology, Department of Psychology and Neuroscience, Duke University, Durham, North Carolina
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47
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Shahrir S, Tindle HA, McGinnis KA, Fiellin DA, Goulet J, Akgün KM, Gibert CL, Rodriguez-Barradas MC, Crothers K. Contemplation of smoking cessation and quit attempts in human immunodeficiency virus-infected and uninfected veterans. Subst Abus 2015; 37:315-22. [PMID: 26167725 DOI: 10.1080/08897077.2015.1062458] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND As antiretroviral treatments prolong life in human immunodeficiency virus (HIV)-infected patients, smoking cessation is now a top priority. However, studies of HIV-infected smokers have not been conducted with uninfected controls. In this study, researchers determined factors associated with contemplating smoking cessation and making a prior quit attempt among HIV-infected and uninfected smoking veterans. METHODS Between 2005 and 2007, 1,027 HIV-infected and 794 uninfected smokers were identified as part of the Veterans Aging Cohort Study (VACS). Stratifying by HIV status, adjusted odds ratios (AORs) were calculated using logistic regression to identify factors associated with contemplating smoking cessation and making a prior quit attempt. RESULTS Most participants (66 % of HIV-infected vs. 68 % of uninfected; P = .46) were contemplating cessation, and 56 % of both groups (P = .99) had attempted to quit in the last year. In stratified multivariable analyses, HIV-infected smokers with recent pulmonary disease diagnoses were more likely to have made a quit attempt (AOR = 4.93, 95 % confidence interval [CI] = 1.41-17.17). Both HIV-infected and uninfected patients with unhealthy alcohol use were less likely to be contemplating cessation (AOR = 0.66, 95 % CI = 0.49-0.90 and 0.71, 95 % CI = 0.50-1.00). HIV-infected smokers who reported unhealthy alcohol use were also less likely to have made a quit attempt in the last year (AOR = 0.68, 95 % CI = 0.51-0.91). CONCLUSIONS Patient-level interest and motivation are not major barriers to smoking cessation among HIV-infected veterans. Targeting HIV-infected smokers with a recent pulmonary disease diagnosis may improve sustained smoking cessation. Unhealthy alcohol use appears to be a key modifiable risk factor. Smoking cessation rates may be improved by combining interventions for smoking and alcohol use for HIV-infected patients.
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Affiliation(s)
- Shahida Shahrir
- a Harborview Medical Center, University of Washington , Seattle , Washington , USA
| | - Hilary A Tindle
- b University of Pittsburgh School of Medicine , Pittsburgh , Pennsylvania , USA
| | | | - David A Fiellin
- d Yale University School of Medicine , New Haven , Connecticut , USA
| | - Joseph Goulet
- c VA Connecticut HealthCare System , West Haven , Connecticut , USA.,d Yale University School of Medicine , New Haven , Connecticut , USA
| | - Kathleen M Akgün
- c VA Connecticut HealthCare System , West Haven , Connecticut , USA.,d Yale University School of Medicine , New Haven , Connecticut , USA
| | | | | | - Kristina Crothers
- a Harborview Medical Center, University of Washington , Seattle , Washington , USA
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48
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Zyambo CM, Willig JH, Cropsey KL, Carson AP, Wilson C, Tamhane AR, Westfall AO, Burkholder GA. Factors Associated With Smoking Status among HIV-Positive Patients in Routine Clinical Care. ACTA ACUST UNITED AC 2015; 6. [PMID: 26767146 PMCID: PMC4707973 DOI: 10.4172/2155-6113.1000480] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Treatment-related reductions in morbidity and mortality among human immunodeficiency virus (HIV)-positive patients have been attenuated by cigarette smoking, which increases risk of cardiovascular, respiratory, and neoplastic diseases. This study investigated factors associated with smoking status among HIV-positive patients. METHODS This cross-sectional study included 2,464 HIV-positive patients attending the HIV Clinic at the University of Alabama at Birmingham between April 2008 and December 2013. Smoking status (current, former, never), psychosocial factors, and clinical characteristics were assessed. Multinomial logistic regression was used to obtain unadjusted and adjusted odds ratios (OR) and 95% confidence intervals (CI) for the association of the various factors with smoking status. RESULTS Among HIV-positive patients (mean age 45 years, 75% male, 55% African-American), the majority reported a history of smoking (39% current and 22% former smokers). In adjusted models, patient characteristics associated with increased odds of current smoking were male gender (OR for heterosexual men, 1.8 [95% CI: 1.3-2.6]; for men who have sex with men, 1.5 [1.1-1.9]), history of respiratory diseases (1.5 [1.2-1.9]), unsuppressed HIV viral load (>50 copies/mL) (1.5 [1.1-1.9]), depression (1.6 [1.3-2.0]), anxiety (1.6 [1.2-2.1]), and prior and current substance abuse (4.7 [3.6-6.1] and 8.3 [5.3-13.3] respectively). Male gender, anxiety, and substance abuse were also associated with being a former smoker. CONCLUSIONS Smoking was common among HIV-positive patients, with several psychosocial factors associated with current and former smoking. This suggests smoking cessation programs in HIV clinic settings may achieve greater impact by integrating interventions that also address illicit substance abuse and mental health.
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Affiliation(s)
- Cosmas M Zyambo
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, USA; Division of Infectious Diseases, School of Medicine, University of Alabama at Birmingham, USA; Department of Public Health, School of Medicine, University of Zambia, Zambia
| | - James H Willig
- Division of Infectious Diseases, School of Medicine, University of Alabama at Birmingham, USA
| | - Karen L Cropsey
- Department of Psychiatry, School of Medicine, University of Alabama at Birmingham, USA
| | - April P Carson
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, USA
| | - Craig Wilson
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, USA
| | - Ashutosh R Tamhane
- Division of Infectious Diseases, School of Medicine, University of Alabama at Birmingham, USA; Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, USA
| | - Andrew O Westfall
- Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, USA
| | - Greer A Burkholder
- Division of Infectious Diseases, School of Medicine, University of Alabama at Birmingham, USA
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49
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Patel R, Moore T, Cooper V, McArdle C, Perry N, Cheek E, Gainsborough N, Fisher M. An observational study of comorbidity and healthcare utilisation among HIV-positive patients aged 50 years and over. Int J STD AIDS 2015; 27:628-37. [PMID: 26068965 DOI: 10.1177/0956462415589524] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Accepted: 04/20/2015] [Indexed: 11/16/2022]
Abstract
The number of HIV-positive people aged ≥50 years is rising each year. We measured the prevalence of non-infectious illnesses and their risk factors and described healthcare use in this UK population. A cross-sectional, observational study was conducted at an outpatient HIV specialist clinic in south east England. Patients age ≥50 years were invited to complete questionnaires measuring demographics, non-infectious illnesses, medication use, lifestyle and healthcare utilisation. The response rate was 67%. Of 299 participants, 84% reported ≥1 comorbid condition and 61% reported ≥2 (multimorbidity). Most commonly reported were high cholesterol, sexual dysfunction, hypertension and depression. In multivariate analyses, age, number of years HIV-positive and duration of antiretroviral therapy remained significant predictors of comorbidity when controlling for lifestyle factors (exercise, smoking and use of recreational drugs and alcohol). Use of non-HIV healthcare services was associated with increasing comorbidity, a longer duration of HIV and recreational drug use. The majority of HIV-patients aged ≥50 years reported multiple comorbidities and this was associated with polypharmacy and increased use of non-HIV services. Further research examining the quality, safety and patient experience of healthcare is needed to inform development of services to optimally meet the needs of older HIV-positive patients.
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Affiliation(s)
- Roshani Patel
- HIV/GUM Research, Brighton and Sussex University Hospitals NHS Trust, London, UK
| | - Thomas Moore
- HIV/GUM Research, Brighton and Sussex University Hospitals NHS Trust, London, UK
| | - Vanessa Cooper
- HIV/GUM Research, Brighton and Sussex University Hospitals NHS Trust, London, UK
| | - Conor McArdle
- HIV/GUM Research, Brighton and Sussex University Hospitals NHS Trust, London, UK
| | - Nicky Perry
- Brighton and Sussex Medical School, Brighton, UK
| | - Elizabeth Cheek
- School of Computing, Engineering and Mathematics, University of Brighton, Brighton, UK
| | - Nicola Gainsborough
- HIV/GUM Research, Brighton and Sussex University Hospitals NHS Trust, London, UK Brighton and Sussex Medical School, Brighton, UK
| | - Martin Fisher
- HIV/GUM Research, Brighton and Sussex University Hospitals NHS Trust, London, UK Brighton and Sussex Medical School, Brighton, UK
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50
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Rao PSS, Kumar S. Polycyclic aromatic hydrocarbons and cytochrome P450 in HIV pathogenesis. Front Microbiol 2015; 6:550. [PMID: 26082767 PMCID: PMC4451413 DOI: 10.3389/fmicb.2015.00550] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Accepted: 05/19/2015] [Indexed: 12/19/2022] Open
Abstract
High prevalence of cigarette smoking in HIV patients is associated with increased HIV pathogenesis and disease progression. While the effect of smoking on the occurrence of lung cancer has been studied extensively, the association between smoking and HIV pathogenesis is poorly studied. We have recently shown the possible role of cytochrome P450 (CYP) in smoking/nicotine-mediated viral replication. In this review, we focus on the potential role of CYP pathway in polycyclic aromatic hydrocarbons (PAH), important constituents of cigarette smoke, mediated HIV pathogenesis. More specifically, we will discuss the role of CYP1A1 and CYP1B1, which are the major PAH-activating CYP enzymes. Our results have shown that treatment with cigarette smoke condensate (CSC) increases viral replication in HIV-infected macrophages. CSC contains PAH, which are known to be activated by CYP1A1 and CYP1B1 into procarcinogens/toxic metabolites. The expression of these CYPs is regulated by aryl hydrocarbon receptors (AHR), the cellular target of PAH, and an important player in various diseases including cancer. We propose that PAH/AHR-mediated CYP pathway is a novel target to develop new interventions for HIV positive smokers.
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Affiliation(s)
- P S S Rao
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Tennessee Health Science Center , Memphis, TN, USA
| | - Santosh Kumar
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Tennessee Health Science Center , Memphis, TN, USA
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