A new focus in HIV care: Smoking cessation

Issue: December 2016

ByAbimbola Farinde, PhD

Since its formal presentation into American society in the early 1980s, HIV has become a widely known but also challenging condition for individuals who become infected. However, over time, improved quality of life has come as result of newer and more potent antiretroviral drugs being released on the market. The comparison of the landscape of the availability of antiretroviral agents in the 1980s to now has seen a dramatic increase in drug options. In the United States, it is reported that approximately 40,000 people are diagnosed with HIV each year and 1.2 million people are living with the disease, and nearly 37 million people are living with HIV around the world.

From a medical standpoint, the characteristic feature of the HIV virus is that it attacks the immune system of the infected individual, and without this strong immune system in place the body can be susceptible to developing diseases and experiences trouble with fighting off infections. The ability to effectively fight off infections is a primary aspect of human survival. There has been an ongoing global fight against HIV/AIDS, which has led to some progress being made, but the epidemic still exists in the U.S. and other international communities. In our present-day society, the diagnosis of HIV is not always viewed as a death sentence because of achievements in HIV care, but with this diagnosis significant lifestyle changes must be adopted to help increase the likelihood of survival.

According to a recent report, the life expectancy of people with HIV continues to improve because of new treatments that are helping HIV patients reach old age. The average HIV–infected person is expected to live to the age of approximately 74 years, compared with about 80 years for those in the general population.

While the existence of antiretroviral drugs has helped to prolong lives, lifestyle behaviors such as smoking have been found to have a profoundly negative impact on life expectancy. Even though individuals with HIV may realize the benefits that can come from their antiretroviral medications, more than 40% of HIV–infected people smoke cigarettes in the U.S. This rampant behavior has the potential to counteract the benefits of the antiretroviral drugs and defeat the goal of HIV management, which is to achieve the best possible outcome. The potential of smoking to have a greater negative impact on life expectancy than the HIV infection itself is of concern because the former can be modified if the individual is willing to stop the behavior. A provider that specializes in HIV care should advise on the consequences of smoking and educate on the benefits that can be achieved with immediate cessation.

The issue of smoking cessation is one that should be viewed as a priority in HIV care and addressed during each visit because of the significant impact that it can have on survival. If an HIV–infected individual stops smoking, there is the potential for years of life to be regained. A cornerstone of HIV care and success with management is the adoption of positive lifestyle changes, and while smoking cessation interventions have not been a large focus in the past, it must be placed at the forefront of care because it can be a major cause of morbidity and mortality in this population.

References:
CDC. HIV in the United States: At A Glance. http://www.cdc.gov/hiv/statistics/overview/ataglance.html. Accessed November 9, 2016.
Heitz D. Life Expectancy for People with HIV Continues to Improve. Healthline. Aug. 8, 2016. http://www.healthline.com/health-news/hiv-life-expectancy-for-americans-with-hiv-reaches-parity-121813. Accessed November 9, 2016.
Lohse N, et al. Ann Intern Med. 2016;doi:10.7326/L16-0091.
Reddy KP, et al. J Infect Dis. 2016;doi:10.1093/infdis/jiw430.
UNAIDS. Fact sheet 2016. http://www.unaids.org/en/resources/fact-sheet. Accessed November 9, 2016.

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Abimbola Farinde, PhD, is a professor at Columbia Southern University, Orange Beach, Ala.

Disclosure: Farinde reports no relevant financial disclosures.