Factors Associated with Tobacco Smoking and Cessation among HIV-Infected Individuals under Care in Rio de Janeiro, Brazil
Editor: Anil Kumar, University of Missouri-Kansas
City, United States of America
Received: June
Factors Associated with Tobacco Smoking and Cessation among HIV-Infected Individuals under Care in Rio de Janeiro, Brazil
Thiago S. Torres * 0
Paula M. Luz 0
Monica Derrico 0
Luciane Velasque 0 1
Eduarda Grinsztejn 0
Valdil ea G. Veloso 0
Sandra W. Cardoso 0
Marlia Santini-Oliveira 0
Beatriz Grinsztejn 0
Raquel Brandini De Boni 0
0 Instituto de Pesquisa Cl nica Evandro Chagas, Fundac a o Oswaldo Cruz, HIV/AIDS Clinical Research Center , Rio de Janeiro , Brazil,
1 Departamento de Matema tica , Universidade Federal do Estado do Rio de Janeiro (UniRio) , Brazil
Worldwide the prevalence of smoking among people living with HIV/AIDS is elevated compared to the general population. This probably reflects the cluster of individual characteristics that have shared risk factors for HIV infection and smoking. A cross-sectional study, enrolling a convenience sample from a Brazilian HIV clinical cohort was conducted to evaluate the prevalence of tobacco smoking and the factors associated with current smoking and abstinence. A total of 2,775 HIV-infected individuals were interviewed: 46.2% have never smoked, 29.9% were current smokers and 23.9% were former smokers. Current smokers had a higher prevalence of alcohol and illicit drug use when compared to the other two groups. A higher proportion of heterosexual individuals were former smokers or never smokers while among men who have sex with men (MSM) a higher proportion were current smokers. Former smokers had been more frequently diagnosed with high blood pressure, diabetes mellitus, cardiovascular diseases and depression, while for current smokers lung diseases were more frequent. Former smokers and current smokers were more likely to have had any hospital admission (42.0% and 41.2%, respectively) than participants who never smoked (33.5%) (p,0.001). Multivariate model results showed that current smokers (versus never smokers) were more likely to be less educated, to report the use of alcohol, crack and cocaine and to present clinical comorbidities. Former smokers (versus current smokers) were more likely to be older, to have smoked for a shorter amount of time and to have smoked .31 cigarettes/day. MSM (compared to heterosexuals) and cocaine users (versus non-users) had lower odds of being former smokers.
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Considering our results, smoking cessation interventions should be tailored to
younger individuals, MSM and substance users.
The prevalence of smoking among people living with HIV/AIDS is elevated
compared to the general population in both high income countries [16] and low
or middle income countries (LMIC) [711], although up to 70% of smokers live
in LMIC [12]. This probably reflects the cluster of individual characteristics that
have shared risk factors for HIV infection and smoking (e.g. younger age, low
education level, low socioeconomic status, illicit drug and alcohol use), rather
than being a causal relationship [6, 13, 14].
Smoking is a well-established risk factor for several comorbid conditions
among HIV-infected individuals, including: pulmonary infectious diseases, non
AIDS-defining cancers (e.g. lung cancer), cardiovascular diseases (CVD) and
tuberculosis [1523]. Some authors have highlighted significant association
between nicotine dependence, depression and combined antiretroviral therapy
(cART) poor-adherence [11, 24, 25], but it increases all-cause mortality, even after
controlling for CD4+ T-cell count and HIV viral load [5, 1523, 2628].
Additionally, it may limit the effectiveness of cART by promoting HIV-1 gene
expression [29]. Recent findings suggest that HIV-infected smokers report a desire
to quit but may have substantial difficulties in the process. It is believed that these
difficulties may be strengthened by comorbid psychiatric conditions and social
support networks comprised mainly by other smokers [3033].
In Brazil, after several regulatory policies, the prevalence of smoking in the
general population has declined and it is estimated at 14.8% among the general
population [34]. However, very limited data is available on the prevalence of
smoking among individual living with HIV/AIDS in the country [7]. The
understanding of factors associated with smoking and smoking cessation is crucial
to plan targeted interventions for these individuals. The aim of this study is to
describe the prevalence of tobacco smoking as well as the factors associated with
current smoking and abstinence in a sample of HIV-infected individuals under
care at the Instituto de Pesquisa Clnica Evandro Chagas/FIOCRUZ (IPEC)
clinical cohort.
Materials and Methods
This was a cross-sectional study that enrolled a convenience sample selected
within the population of the IPEC/FIOCRUZ clinical cohort that had at least one
clinical appointment between January 01, 2011 and July 31, 2013.
Details of the cohort procedures, definitions and results have been described in
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