Editorial – The Shifting Paradigm of Care for Adults Living With HIV – Smoking Cessation for Longer Life
Journal of Infectious Diseases December 1, 2016 V.214 N.11 P.1618-1620
Keri N. Althoff
Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
There are few truths in medical science that are as agreed upon as this: smoking is bad for health. In persons with human immunodeficiency virus (HIV) infection, smoking is a scourge, with recent prevalence estimates of 42%, which Reddy et al, in this issue of The Journal of Infectious Diseases, translated to an estimated 247 586 smokers among those in HIV care in the United States [1, 2]. It is hypothesized that adults living with HIV start smoking at younger ages, smoke more heavily and for a longer duration, and have lower rates of cessation than the general population in the United States. However, population-based estimates are not available. The problem may seem insurmountable, particularly because a delay in the manifestations of harm from smoking creates a lack of urgency for cessation. Because the HIV infection paradigm has changed from an acutely terminal illness to a chronic infection with a life expectancy approaching that of uninfected adults, the paradigm of how we protect the health of people living with HIV has also evolved.
Reddy et al estimate a gain in life expectancy of 5.7 years among men and 4.6 years among women who quit smoking upon entering into HIV care . The authors predict that if a quarter of HIV-infected adults quit smoking, 265 000 years of life could be regained at the population level. It is reasonable to assume that there is also an increased quality of life, not only quantity of life, given the strong associations of smoking with a poorer immunologic response to antiretroviral therapy (ART) and the development of cancer, cardiovascular disease, chronic obstructive pulmonary disease, and lower respiratory tract infections . After accounting for nonadherence to …