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Rakesh G, Adams TG, Morey RA, Alcorn JL, Khanal R, Su AE, Himelhoch SS, Rush CR. Intermittent theta burst stimulation and functional connectivity in people living with HIV/AIDS who smoke tobacco cigarettes: a preliminary pilot study. Front Psychiatry 2024; 15:1315854. [PMID: 38501083 PMCID: PMC10945607 DOI: 10.3389/fpsyt.2024.1315854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 01/30/2024] [Indexed: 03/20/2024] Open
Abstract
Background People living with HIV (PLWHA) smoke at three times the rate of the general population and respond poorly to cessation strategies. Previous studies examined repetitive transcranial magnetic stimulation (rTMS) over left dorsolateral prefrontal cortex (L. dlPFC) to reduce craving, but no studies have explored rTMS among PLWHA who smoke. The current pilot study compared the effects of active and sham intermittent theta-burst stimulation (iTBS) on resting state functional connectivity (rsFC), cigarette cue attentional bias, and cigarette craving in PLWHA who smoke. Methods Eight PLWHA were recruited (single-blind, within-subject design) to receive one session of iTBS (n=8) over the L. dlPFC using neuronavigation and, four weeks later, sham iTBS (n=5). Cigarette craving and attentional bias assessments were completed before and after both iTBS and sham iTBS. rsFC was assessed before iTBS (baseline) and after iTBS and sham iTBS. Results Compared to sham iTBS, iTBS enhanced rsFC between the L. dlPFC and bilateral medial prefrontal cortex and pons. iTBS also enhanced rsFC between the right insula and right occipital cortex compared to sham iTBS. iTBS also decreased cigarette craving and cigarette cue attentional bias. Conclusion iTBS could potentially offer a therapeutic option for smoking cessation in PLWHA.
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Affiliation(s)
- Gopalkumar Rakesh
- Department of Psychiatry, College of Medicine, University of Kentucky, Lexington, KY, United States
| | - Thomas G. Adams
- Department of Psychology, College of Arts & Sciences, University of Kentucky, Lexington, KY, United States
| | - Rajendra A. Morey
- Brain Imaging and Analyses Center (BIAC), Duke University Medical Center, Durham, NC, United States
| | - Joseph L. Alcorn
- Department of Behavioral Sciences, College of Medicine, University of Kentucky, Lexington, KY, United States
| | - Rebika Khanal
- Department of Psychiatry, College of Medicine, University of Kentucky, Lexington, KY, United States
| | - Amanda E. Su
- Department of Psychiatry, University of Texas Southwestern Medical School, Dallas, TX, United States
| | - Seth S. Himelhoch
- Department of Psychiatry, College of Medicine, University of Kentucky, Lexington, KY, United States
| | - Craig R. Rush
- Department of Behavioral Sciences, College of Medicine, University of Kentucky, Lexington, KY, United States
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Moreira RDC, Rodrigues A, Leonardo BM, Arabe D, Santos R, Cardoso SW, Grinsztejn B, Veloso V, Pacheco AG. Smoking Cessation Is Associated With Short-Term Improvement of Vascular Health in a Cohort of People Living With HIV in Rio de Janeiro, Brazil. Am J Cardiol 2024; 214:157-166. [PMID: 38160920 DOI: 10.1016/j.amjcard.2023.12.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 11/24/2023] [Accepted: 12/17/2023] [Indexed: 01/03/2024]
Abstract
Smoking is highly prevalent in people living with HIV/AIDS (PLHA), leading to detrimental effects in different tissues. We examined the effects of nicotine replacement therapy (NRT) on smoking cessation and vascular health. From December 2019 to October 2021, we prospectively enrolled PLHA who were actively smoking. The primary outcome was endothelial function measured by brachial artery flow-mediated dilatation (FMD). We evaluated the percent change in FMD compared to the baseline measure (Δ%FMD) to detect improvements among participants who quit smoking. To confirm the results, we used linear regression models to account for classical cardiovascular (CV) confounders. We included 117 participants with median age of 45.5 years (IQR= 36.4-54.8); 22 (20.4%) had hypertension, 9 (8.3%) had diabetes, almost half were smoking 20+ cigarettes/day (41.7%). After 12 weeks 30.76% participants quit smoking. Comparison of Δ%FMD change from baseline to week 12 showed that among participants adherent to therapy, there has been an increase in Δ%FMD when compared to those who relapsed (1.17% [0.29-2.98] vs -0.19% [-1.95-0.91], p<0.001). After adjustment for CV factors, multiple linear regression showed that Δ%FMD in participants who quit smoking presented a 2.54 mean increase in comparison to those who continued smoking (p=0.007). In conclusion, this study provides evidence that a strategy of NRT and counseling is modestly effective for smoking cessation in PLHA and improves vascular health in a short period of time. This reinforces the importance of the widespread anti-tobacco programs in HIV clinics and the expected impact lowering the incidence of future cardiovascular events.
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Affiliation(s)
| | | | | | - Daniel Arabe
- Evandro Chagas National Institute of Infectology, Rio de Janeiro, Brazil
| | - Renata Santos
- Evandro Chagas National Institute of Infectology, Rio de Janeiro, Brazil
| | | | - Beatriz Grinsztejn
- Evandro Chagas National Institute of Infectology, Rio de Janeiro, Brazil
| | - Valdilea Veloso
- Evandro Chagas National Institute of Infectology, Rio de Janeiro, Brazil
| | - Antonio G Pacheco
- Scientific Computing Program of Oswaldo Cruz Fundation (PROCC), Rio de Janeiro, Brazil
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A Schulz J, Regnier SD, Erath TG, Mullis LC, Nugent A, Atwood GS, Villanti AC. Smoking cessation interventions for U.S. adults with disabilities: A systematic review. Addict Behav 2024; 149:107905. [PMID: 37977010 PMCID: PMC10842129 DOI: 10.1016/j.addbeh.2023.107905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 10/13/2023] [Accepted: 11/03/2023] [Indexed: 11/19/2023]
Abstract
INTRODUCTION People with disabilities disproportionately use tobacco products. However, little is known about cessation interventions tailored for people with disabilities. The objective of this study was to conduct a systematic review of smoking cessation interventions for adults with disabilities. METHODS Six electronic databases (Cochrane, CINAHL Plus [EBSCOhost], Embase [Ovid], Medline [Ovid], PsycINFO [Ovid], and Web of Science) were searched to identify eligible interventions for people with disabilities (e.g., vision, hearing, mobility, communication, cognition, self-care) through July 2023. Two independent coders evaluated the records and extracted data from studies that met inclusion criteria. Qualitative synthesis was conducted on the included studies in 2023. RESULTS One randomized controlled trial and one nonrandomized study met the inclusion criteria. Both studies used mindfulness-based procedures to reduce cigarette use in adults with mild intellectual disability. The outcome was defined as self-reported cigarette use at follow-up, which ranged from 1 year to 3 years. Limited information was provided on how the interventions were tailored to meet the unique needs of people with disabilities in either study. CONCLUSION Two interventions conducted in adults with mild intellectual disability showed promising results using mindfulness-based procedures; however, the studies did not address barriers reported by people with disabilities, nor tailor the interventions to meet the needs of the target population. Research is needed to address tobacco use disparities among people with a range of disabilities. Current cessation interventions would be enhanced by integrating disability identifiers alongside other demographic information in future studies and reporting subgroup analyses in adults with disabilities.
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Affiliation(s)
- Jonathan A Schulz
- Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont, Burlington, VT, USA.
| | - Sean D Regnier
- Department of Behavioral Science, University of Kentucky, College of Medicine, USA
| | - Tyler G Erath
- Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont, Burlington, VT, USA
| | | | - Austin Nugent
- Human Development Institute, University of Kentucky, USA
| | - Gary S Atwood
- Dana Health Sciences Library, University of Vermont, Burlington, VT, USA
| | - Andrea C Villanti
- Rutgers Institute for Nicotine & Tobacco Studies, New Brunswick, NJ, USA; Department of Health Behavior, Society, and Policy, Rutgers School of Public Health, Piscataway, NJ, USA
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Wipfli H, Arinaitwe J, Goma F, Atuyambe L, Guwatudde D, Phiri MM, Rutebemberwa E, Wabwire-Mangen F, Zulu R, Zyambo C, Guy K, Kusolo R, Mukupa M, Musasizi E, Tucker JS. A phone-based tobacco use cessation program for people living with HIV in Uganda and Zambia: study protocol for a randomized controlled trial. Addict Sci Clin Pract 2024; 19:6. [PMID: 38243301 PMCID: PMC10797805 DOI: 10.1186/s13722-024-00438-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 01/05/2024] [Indexed: 01/21/2024] Open
Abstract
BACKGROUND Nicotine replacement therapy (NRT) and short messaging service (SMS)-based tobacco cessation interventions have demonstrated effectiveness in reducing tobacco use in many populations, but evidence is needed on which tailored treatments are most efficacious in meeting the complex medical and psychosocial factors confronting people living with HIV (PLWH) in sub-Saharan Africa (SSA). This paper describes the protocol of a study to test the efficacy of both NRT and a tailored SMS-based tobacco use cessation intervention among PLWH in Uganda and Zambia. METHODS In a randomized controlled trial, 800 adult PLWH who use tobacco will be recruited by health care professionals at HIV treatment centers where they are receiving care. Participants will be randomized to one of the four study arms: (1) standard of care [SOC; brief clinician advice to quit combined with HIV education and information aimed at encouraging HIV treatment adherence (with no mention of tobacco) delivered via text messages]; (2) SOC + 12 weeks of NRT; (3) SOC + 6 weeks of SMS text messages to support quitting tobacco use (SMS); or (4) SOC + NRT + SMS. Participants will receive a cell phone and solar panel with power bank for charging the phone. The main outcome is cessation of tobacco use by study participants verified by urinary cotinine (< 15 ng/mL) at 6 months post-enrollment. As a secondary tobacco use outcome, we will measure 7-day point-prevalence abstinence (7 consecutive days of no tobacco use) measured by self-report and biochemically-verified at 4 weeks, 8 weeks, and 3 months post enrollment. DISCUSSION Our study will provide insight into the efficacy, feasibility and applicability of delivering tobacco cessation interventions through health care professionals combined with tailored tobacco cessation SMS text messaging in two countries with different tobacco use patterns, policy environments, and health care resources and provide needed information to providers and policymakers looking for cost-effective tobacco cessation interventions. The previously tested SMS-platform to be used in our study is uniquely positioned to be scaled in low- and middle-income countries worldwide, in which case evidence of even modest success in reducing the prevalence of tobacco consumption among PLWH could confer enormous health and economic benefits. TRIAL REGISTRATION ClinicalTrials.gov Identifier NCT05487807. Registered August 4, 2022, https://clinicaltrials.gov/ct2/show/record/NCT05487807.
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Affiliation(s)
- Heather Wipfli
- Keck School of Medicine, Department of Preventative Medicine, University of Southern California, 2001 N. Soto Street, Los Angeles, CA, 90033, USA.
| | - Jim Arinaitwe
- School of Public Health, Makerere University, Centre for Tobacco Control in Africa, Kampala, Uganda
| | - Fastone Goma
- School of Medicine, University of Zambia, Centre For Primary Care Research, Lusaka, Zambia
| | - Lynn Atuyambe
- School of Public Health, Department of Community Health and Behavioural Sciences, Makerere University, Kampala, Uganda
| | - David Guwatudde
- Department of Epidemiology and Biostatistics, Makerere University School of Public Health, Kampala, Uganda
| | - Masauso Moses Phiri
- School of Medicine, University of Zambia, Centre For Primary Care Research, Lusaka, Zambia
- School of Medicine, Department of Pathology and Microbiology, University of Zambia, Lusaka, Zambia
| | - Elizeus Rutebemberwa
- School of Public Health, Department of Health Policy, Makerere University, Planning, and Management, Kampala, Uganda
| | - Fred Wabwire-Mangen
- Department of Epidemiology and Biostatistics, Makerere University School of Public Health, Kampala, Uganda
| | - Richard Zulu
- School of Medicine, University of Zambia, Centre For Primary Care Research, Lusaka, Zambia
| | - Cosmas Zyambo
- School of Public Health, Department of Community and Family Medicine, University of Zambia, Lusaka, Zambia
| | - Kyra Guy
- Keck School of Medicine, Department of Preventative Medicine, University of Southern California, 2001 N. Soto Street, Los Angeles, CA, 90033, USA
| | - Ronald Kusolo
- School of Public Health, Makerere University, Centre for Tobacco Control in Africa, Kampala, Uganda
| | - Musawa Mukupa
- School of Medicine, University of Zambia, Centre For Primary Care Research, Lusaka, Zambia
| | - Ezekiel Musasizi
- School of Public Health, Makerere University, Centre for Tobacco Control in Africa, Kampala, Uganda
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Medaglio D, Bilker WB, Han X, Merlin JS, Plankey M, Martin J, Crane HM, Hojat LS, Bamford L, Schnoll R, Tyndale RF, Ashare RL, Gross R. Nicotine Metabolite Ratio Decreases After Switching Off Efavirenz-Based Therapy in People With HIV Who Smoke. Clin Pharmacol Ther 2024; 115:80-85. [PMID: 37787039 PMCID: PMC10752215 DOI: 10.1002/cpt.3068] [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: 06/13/2023] [Accepted: 09/14/2023] [Indexed: 10/04/2023]
Abstract
Rates of cigarette smoking in people with HIV (PWH) are two to three times higher than in people without HIV. Nicotine is metabolized by CYP2A6 and the nicotine metabolite ratio (NMR; 3-hydroxycotinine/cotinine) is a measure of nicotine clearance. Higher NMR has been observed in PWH and is associated with lower quit rates. Efavirenz, a mainstay antiretroviral therapy (ART) globally, partially upregulates its own metabolism through CYP2A6. We hypothesized that efavirenz also upregulates nicotine metabolism by CYP2A6, resulting in a higher NMR, and switching to non-efavirenz ART would decrease the NMR, potentially leading to improved quit rates. We compared the NMR during and after efavirenz use among PWH in a longitudinal, multisite cohort. Eligibility criteria included: (i) active cigarette smoking, (ii) ART switched from efavirenz-based to non-efavirenz-based regimen, (iii) plasma available at pre- and post-ART switch, and (iv) viral suppression during study period. Plasma cotinine and 3-hydroxycotinine were measured by liquid chromatography-tandem mass spectrometry. T-tests compared the NMR on and off efavirenz. Samples were collected between 2010 and 2019 in 72 PWH. The mean NMR difference after switching to a non-efavirenz-based regimen was -0.24 (SD: 0.37, P < 0.001); 44 PWH had at least a 0.1 decrease in NMR. Effect modification by race was present; Black PWH had a larger mean decrease. Our findings suggest that previously observed higher NMR among PWH may be due to direct pharmacologic effects of ART. Assessing the effect of ART on the NMR suggests that avoiding nicotine metabolism inducers could potentially increase quit rates.
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Affiliation(s)
- Dominique Medaglio
- Department of Epidemiology, Biostatistics & Informatics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Warren B. Bilker
- Department of Epidemiology, Biostatistics & Informatics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Xiaoyan Han
- Department of Epidemiology, Biostatistics & Informatics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jessica S. Merlin
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Michael Plankey
- Department of Medicine, Georgetown University, Washington, DC, USA
| | - Jeffrey Martin
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA
| | - Heidi M. Crane
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Leila S. Hojat
- Department of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - Laura Bamford
- Department of Medicine, University of California San Diego, San Diego, California, USA
| | - Robert Schnoll
- Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Rachel F. Tyndale
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Department of Pharmacology & Toxicology, University of Toronto, Toronto, Ontario, Canada
- The Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Rebecca L. Ashare
- Department of Psychology, State University of New York at Buffalo, Buffalo, New York, USA
| | - Robert Gross
- Department of Epidemiology, Biostatistics & Informatics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Byanova KL, Abelman R, North CM, Christenson SA, Huang L. COPD in People with HIV: Epidemiology, Pathogenesis, Management, and Prevention Strategies. Int J Chron Obstruct Pulmon Dis 2023; 18:2795-2817. [PMID: 38050482 PMCID: PMC10693779 DOI: 10.2147/copd.s388142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 11/09/2023] [Indexed: 12/06/2023] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is a progressive respiratory disorder characterized by airflow limitation and persistent respiratory symptoms. People with HIV (PWH) are particularly vulnerable to COPD development; PWH have demonstrated both higher rates of COPD and an earlier and more rapid decline in lung function than their seronegative counterparts, even after accounting for differences in cigarette smoking. Factors contributing to this HIV-associated difference include chronic immune activation and inflammation, accelerated aging, a predilection for pulmonary infections, alterations in the lung microbiome, and the interplay between HIV and inhalational toxins. In this review, we discuss what is known about the epidemiology and pathobiology of COPD among PWH and outline screening, diagnostic, prevention, and treatment strategies.
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Affiliation(s)
- Katerina L Byanova
- Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Rebecca Abelman
- Division of HIV, Infectious Diseases, and Global Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Crystal M North
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Stephanie A Christenson
- Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Laurence Huang
- Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
- Division of HIV, Infectious Diseases, and Global Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
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Brin M, Trujillo P, Jia H, Cioe P, Huang MC, Chen H, Qian X, Xu W, Schnall R. Pilot Testing of an mHealth App for Tobacco Cessation in People Living With HIV: Protocol for a Pilot Randomized Controlled Trial. JMIR Res Protoc 2023; 12:e49558. [PMID: 37856173 PMCID: PMC10623232 DOI: 10.2196/49558] [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: 06/02/2023] [Revised: 08/17/2023] [Accepted: 09/08/2023] [Indexed: 10/20/2023] Open
Abstract
BACKGROUND An estimated 40% of people living with HIV smoke cigarettes. Although smoking rates in the United States have been declining in recent years, people living with HIV continue to smoke cigarettes at twice the rate of the general population. Mobile health (mHealth) technology is an effective tool for people living with a chronic illness, such as HIV, as currently 84% of households in the United States report that they have a smartphone. Although many studies have used mHealth interventions for smoking cessation, few studies have recruited people living with HIV who smoke. OBJECTIVE The objective of the pilot randomized controlled trial (RCT) is to examine the feasibility, acceptability, and preliminary efficacy of the Sense2Quit App as a tool for people living with HIV who are motivated to quit smoking. METHODS The Sense2Quit study is a 2-arm RCT for people living with HIV who smoke cigarettes (n=60). Participants are randomized to either the active intervention condition, which consists of an 8-week supply of nicotine replacement therapy, standard smoking cessation counseling, and access to the Sense2Quit mobile app and smartwatch, or the control condition, which consists of standard smoking cessation counseling and a referral to the New York State Smokers' Quitline. The Sense2Quit app is a mobile app connected through Bluetooth to a smartwatch that tracks smoking gestures and distinguishes them from other everyday hand movements. In the Sense2Quit app, participants can view their smoking trends, which are recorded through their use of the smartwatch, including how often or how much they smoke and the amount of money that they are spending on cigarettes, watch videos with quitting tips, information, and distractions, play games, set reminders, and communicate with a study team member. RESULTS Enrollment of study participants began in March 2023 and is expected to end in October 2023. All data collection is expected to be completed by the end of January 2024. This RCT will test the difference in outcomes between the control and intervention arms. The primary outcome will be the percentage of participants with biochemically verified 7-day point prevalence smoking or tobacco abstinence at their 12-week follow-up. Results from this pilot study will be disseminated to the research community following the completion of all data collection. CONCLUSIONS The Sense2Quit study leverages mHealth so that it can help smokers improve their efforts at smoking cessation. Our research has the potential to not only increase quitting rates among people living with HIV who may need a prolonged, tailored intervention but also inform further development of mHealth for people living with HIV. This mHealth study will contribute significant findings to the greater mHealth research community, providing evidence as to how mHealth should be developed and tested among the target population. TRIAL REGISTRATION ClinicalTrials.gov NCT05609032; https://clinicaltrials.gov/study/NCT05609032. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/49558.
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Affiliation(s)
- Maeve Brin
- Columbia University School of Nursing, New York City, NY, United States
| | - Paul Trujillo
- Columbia University School of Nursing, New York City, NY, United States
| | - Haomiao Jia
- Columbia University School of Nursing, New York City, NY, United States
| | - Patricia Cioe
- Brown University School of Public Health, Providence, RI, United States
| | - Ming-Chun Huang
- Case Western Reserve University School of Engineering, Cleveland, OH, United States
| | - Huan Chen
- Case Western Reserve University School of Engineering, Cleveland, OH, United States
| | - Xiaoye Qian
- Case Western Reserve University School of Engineering, Cleveland, OH, United States
| | - Wenyao Xu
- Department of Computer Science and Engineering, University at Buffalo, the State University of New York, Buffalo, NY, United States
| | - Rebecca Schnall
- Columbia University School of Nursing, New York City, NY, United States
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Cohen SM, DePhilippis D, Deng Y, Dziura J, Ferguson T, Fucito LM, Justice AC, Maisto S, Marconi VC, Molina P, Paris M, Rodriguez-Barradas MC, Simberkoff M, Petry NM, Fiellin DA, Edelman EJ. Perspectives on contingency management for alcohol use and alcohol-associated conditions among people in care with HIV. ALCOHOL, CLINICAL & EXPERIMENTAL RESEARCH 2023; 47:1783-1797. [PMID: 37524371 PMCID: PMC10828101 DOI: 10.1111/acer.15159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 07/21/2023] [Accepted: 07/25/2023] [Indexed: 08/02/2023]
Abstract
BACKGROUND Contingency management (CM) is an evidence-based approach for reducing alcohol use; however, its implementation into routine HIV primary care-based settings has been limited. We evaluated perspectives on implementing CM to address unhealthy alcohol use and associated conditions for people with HIV in primary care settings. METHODS From May 2021 to August 2021, we conducted two focus groups with staff involved in delivering the intervention (n = 5 Social Workers and n = 4 Research Coordinators) and individual interviews (n = 13) with a subset of participants involved in the multi-site Financial Incentives, Randomization, and Stepped Treatment (FIRST) trial. Qualitative data collection and analyses were informed by the Promoting Action on Research Implementation in Health Service (PARIHS) implementation science framework, including evidence (perception of CM), context (HIV primary care clinic and CM procedures), and facilitation (feasibility outside the research setting). RESULTS Several major themes were identified. Regarding the evidence, participants lacked prior experience with CM, but the intervention was well received and, by some, perceived to lead to lasting behavior change. Regarding the clinical context for the reward schedule, the use of biochemical testing, specifically fingerstick phosphatidylethanol testing, and the reward process were perceived to be engaging and gratifying for both staff and patients. Participants indicated that the intervention was enhanced by its co-location within the HIV clinic. Regarding facilitation, participants suggested addressing the intervention's feasibility for non-research use, simplifying the reward structure, and rewarding non-abstinence in alcohol use. CONCLUSIONS Among patients and staff involved in a clinical trial, CM was viewed as a helpful, positive, and feasible approach to addressing unhealthy alcohol use and related conditions. To enhance implementation, future efforts may consider simplified approaches to the reward structure and expanding rewards to non-abstinent reductions in alcohol consumption.
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Affiliation(s)
- Shawn M. Cohen
- Program in Addiction Medicine, Yale School of Medicine, 367 Cedar Street, Suite 417A, New Haven, CT 06510, USA
- Department of Internal Medicine, Yale School of Medicine, 333 Cedar Street, P.O. Box 208056, New Haven, CT 06510, USA
| | - Dominick DePhilippis
- Veterans Affairs Office of Mental Health and Suicide Prevention, US Department of Veterans Affairs, Washington, D.C. 20420, USA
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Yanhong Deng
- Yale Center for Analytic Sciences, Yale School of Public Health, New Haven, CT 06511, USA
| | - James Dziura
- Yale Center for Analytic Sciences, Yale School of Public Health, New Haven, CT 06511, USA
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT
| | - Tekeda Ferguson
- Department of Epidemiology, Louisiana State University School of Public Health, New Orleans, LA
| | - Lisa M. Fucito
- Department of Psychiatry, Yale School of Medicine
- Yale Cancer Center, New Haven, CT 06510, USA
| | - Amy C. Justice
- Department of Internal Medicine, Yale School of Medicine, 333 Cedar Street, P.O. Box 208056, New Haven, CT 06510, USA
- Yale School of Public Health, New Haven, CT 06510, USA
- Veterans Affairs Connecticut Healthcare System, Veterans Aging Cohort Study, West Haven, CT 06516, USA
| | | | - Vincent C. Marconi
- Atlanta Veterans Affairs Medical Center, Emory University School of Medicine and Rollins School of Public Health, Atlanta, GA 30033, USA
| | - Patricia Molina
- Comprehensive Alcohol-HIV/AIDS Research Center, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA
- Department of Physiology, School of Medicine, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA
| | - Manuel Paris
- Department of Psychiatry, Yale School of Medicine
| | | | - Michael Simberkoff
- Veterans Affairs NY Harbor Healthcare System and New York University School of Medicine, New York, NY 10010, USA
| | - Nancy M. Petry
- Pat and Jim Calhoun Cardiology Center, University of Connecticut School of Medicine, Farmington, CT
| | - David A. Fiellin
- Program in Addiction Medicine, Yale School of Medicine, 367 Cedar Street, Suite 417A, New Haven, CT 06510, USA
- Department of Internal Medicine, Yale School of Medicine, 333 Cedar Street, P.O. Box 208056, New Haven, CT 06510, USA
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT
- Center for Interdisciplinary Research on AIDS, Yale School of Public Health, 135 College Street, Suite 200, New Haven, CT 06510, USA
| | - E. Jennifer Edelman
- Program in Addiction Medicine, Yale School of Medicine, 367 Cedar Street, Suite 417A, New Haven, CT 06510, USA
- Department of Internal Medicine, Yale School of Medicine, 333 Cedar Street, P.O. Box 208056, New Haven, CT 06510, USA
- Center for Interdisciplinary Research on AIDS, Yale School of Public Health, 135 College Street, Suite 200, New Haven, CT 06510, USA
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Filipkowski AM, Kundu S, Eden SK, Alcorn CW, Justice AC, So-Armah KA, Tindle HA, Wells QS, Beckman JA, Freiberg MS, Aday AW. Association of HIV Infection and Incident Abdominal Aortic Aneurysm Among 143 001 Veterans. Circulation 2023; 148:135-143. [PMID: 37226738 PMCID: PMC10443901 DOI: 10.1161/circulationaha.122.063040] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 05/01/2023] [Indexed: 05/26/2023]
Abstract
BACKGROUND People with HIV (PWH) have an increased risk of cardiovascular disease. Previous cross-sectional data suggest there is a higher prevalence of abdominal aortic aneurysm (AAA) in PWH than in those without HIV. Whether PWH have an increased risk of incident AAA compared with those without HIV is unknown. METHODS We analyzed data among participants without prevalent AAA from the Veterans Aging Cohort Study, a prospective, observational, longitudinal cohort of veterans with HIV matched 1:2 with veterans without HIV infection. We calculated AAA rates by HIV status and assessed the association between HIV infection and incident AAA using Cox proportional hazards models. We defined AAA using the International Classification of Diseases, 9th or 10th revision, or Current Procedural Terminology codes and adjusted all models for demographic characteristics, cardiovascular disease risk factors, and substance use. Secondary analyses examined the association between time-varying CD4+ T-cell count or HIV viral load and incident AAA. RESULTS Among 143 001 participants (43 766 with HIV), over a median follow-up of 8.7 years, there were 2431 incident AAA events (26.4% among PWH). Rates of incident AAA per 1000 person-years were similar among PWH (2.0 [95% CI, 1.9-2.2]) and people without HIV (2.2 [95% CI, 2.1-2.3]). There was no evidence that HIV infection increased the risk of incident AAA compared with no HIV infection (adjusted hazard ratio, 1.02 [95% CI, 0.92-1.13]). In adjusted analyses with time-varying CD4+ T-cell counts or HIV viral load, PWH with CD4+ T-cell counts <200 cells/mm3 (adjusted hazard ratio, 1.29 [95% CI, 1.02-1.65]) or HIV viral load ≥500 copies/mL (adjusted hazard ratio, 1.29 [95% CI, 1.09-1.52]) had an increased risk of AAA compared with those without HIV. CONCLUSIONS HIV infection is associated with an increased risk of AAA among those with low CD4+ T-cell counts or elevated HIV viral load over time.
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Affiliation(s)
| | - Suman Kundu
- Vanderbilt Translational and Clinical Cardiovascular Research Center, Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Svetlana K. Eden
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Charles W. Alcorn
- University of Pittsburgh School of Public Health, Pittsburgh, PA, USA
| | - Amy C. Justice
- Veterans Affairs Connecticut Healthcare System, CT, USA
- Department of Internal Medicine, Yale School of Medicine, West Haven, CT, USA
| | - Kaku A. So-Armah
- Division of General Internal Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Hilary A. Tindle
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Quinn S. Wells
- Vanderbilt Translational and Clinical Cardiovascular Research Center, Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Joshua A. Beckman
- Vanderbilt Translational and Clinical Cardiovascular Research Center, Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Matthew S. Freiberg
- Vanderbilt Translational and Clinical Cardiovascular Research Center, Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
- Veterans Affairs Tennessee Valley Healthcare System, Nashville, TN, USA
| | - Aaron W. Aday
- Vanderbilt Translational and Clinical Cardiovascular Research Center, Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
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10
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Kreniske JS, Kaner RJ, Glesby MJ. Pathogenesis and management of emphysema in people with HIV. Expert Rev Respir Med 2023; 17:873-887. [PMID: 37848398 PMCID: PMC10872640 DOI: 10.1080/17476348.2023.2272702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Accepted: 10/16/2023] [Indexed: 10/19/2023]
Abstract
INTRODUCTION Since early in the HIV epidemic, emphysema has been identified among people with HIV (PWH) and has been associated with increased mortality. Smoking cessation is key to risk reduction. Health maintenance for PWH and emphysema should ensure appropriate vaccination and lung cancer screening. Treatment should adhere to inhaler guidelines for the general population, but inhaled corticosteroid (ICS) should be used with caution. Frontiers in treatment include targeted therapeutics. Major knowledge gaps exist in the epidemiology of and optimal care for PWH and emphysema, particularly in low and middle-income countries (LMIC). AREAS COVERED Topics addressed include risk factors, pathogenesis, current treatment and prevention strategies, and frontiers in research. EXPERT OPINION There are limited data on the epidemiology of emphysema in LMIC, where more than 90% of deaths from COPD occur and where the morbidity of HIV is most heavily concentrated. The population of PWH is aging, and age-related co-morbidities such as emphysema will only increase in salience. Over the next 5 years, the authors anticipate novel trials of targeted therapy for emphysema specific to PWH, and we anticipate a growing body of evidence to inform optimal clinical care for lung health among PWH in LMIC.
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Affiliation(s)
- Jonah S. Kreniske
- Division of Pulmonary and Critical Care Medicine, Weill Cornell Medical College, USA
| | - Robert J. Kaner
- Division of Pulmonary and Critical Care Medicine, Weill Cornell Medical College, USA
- Department of Genetic Medicine, Weill Cornell Medical College, USA
| | - Marshall J. Glesby
- Division of Infectious Diseases, Weill Cornell Medical College, USA
- Department of Population Health Sciences, Weill Cornell Medical College, USA
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11
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Cioe PA, Schnoll R, Hoeppner BB, Gross R, Hitsman BL, Leone FT, Ashare R, Vilardaga R, Tashima K, Pinkston M, Kahler CW. The Impact of the COVID-19 Pandemic on Stress, Isolation, Smoking Behaviors, and Motivation to Quit in People with HIV Who Smoke. AIDS Behav 2023; 27:1862-1869. [PMID: 36357808 PMCID: PMC9649403 DOI: 10.1007/s10461-022-03917-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/27/2022] [Indexed: 11/12/2022]
Abstract
People with HIV (PWH) smoke at higher rates compared with the general population and have lower cessation rates. The primary aim of this study was to examine the impact of the COVID-19 pandemic on smoking in PWH. A survey was administered to participants in two smoking cessation trials in the United States. Mean cigarettes per day was 13.9 (SD 8.6), and participants reported they had smoked on average for 30.93 years (SD 10.4). More than half (55.7%) of participants (N = 140) reported not changing their smoking during the pandemic, while 15% reported decreasing, and 25% reported increasing their smoking. In bivariate analyses, worrying about food due to lack of money (χ2 = 9.13, df 2, p = 0.01) and greater Covid-related worry (rs = 0.19, p = 0.02) were significantly associated with increased smoking. Qualitative research may be needed to more clearly elucidate factors related to smoking behaviors among PWH.
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Affiliation(s)
- Patricia A Cioe
- Center for Alcohol & Addiction Studies, Department of Behavioral & Social Sciences, Brown University School of Public Health, Providence, RI, USA.
| | - Robert Schnoll
- Department of Psychiatry and Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Bettina B Hoeppner
- Department of Psychiatry, Recovery Research Institute, Massachusetts General Hospital, Boston, MA, USA
| | - Robert Gross
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA, USA
- Division of Infectious Diseases, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Brian L Hitsman
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Frank T Leone
- Pulmonary, Allergy, & Critical Care Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Rebecca Ashare
- Department of Psychiatry and Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
- Department of Psychology, State University of New York at Buffalo, Buffalo, NY, USA
| | - Roger Vilardaga
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Karen Tashima
- Division of Infectious Diseases, Miriam Hospital, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Megan Pinkston
- Division of Infectious Diseases, Miriam Hospital, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Christopher W Kahler
- Center for Alcohol & Addiction Studies, Department of Behavioral & Social Sciences, Brown University School of Public Health, Providence, RI, USA
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12
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Schulz JA, Atwood GS, Regnier SD, Mullis LC, Nugent A, Erath TG, Villanti AC. Smoking cessation interventions for US adults with disabilities: protocol for a systematic review. BMJ Open 2023; 13:e066700. [PMID: 36948548 PMCID: PMC10040063 DOI: 10.1136/bmjopen-2022-066700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 03/07/2023] [Indexed: 03/24/2023] Open
Abstract
INTRODUCTION People with disabilities have a higher prevalence of cigarette smoking than people without disabilities. However, little information exists on smoking cessation interventions tailored to address the unique needs of people with disabilities. This paper describes a systematic review protocol to identify and evaluate tobacco smoking cessation interventions designed to improve outcomes for people with disabilities. METHODS AND ANALYSIS We will conduct a systematic review of the literature using the procedures outlined by Cochrane. We will search four electronic databases (CINAHL Plus (EBSCO), Embase (Ovid), Medline (Ovid) and PsycINFO (Ovid)) with no date restriction to identify tobacco cessation interventions tailored to meet the needs of people with disabilities. We will extract data and assess risk of bias using the RoB2 and ROBINS-I for included studies using Covidence systematic review software. Quantitative and qualitative syntheses will summarise key study characteristics and outcomes with text, tables and forest plots; a meta-analysis will be conducted, if appropriate. ETHICS AND DISSEMINATION Ethical approval is not required as there are no primary data associated with the study. Data will be disseminated through a peer-reviewed articles and conference presentations. PROSPERO REGISTRATION NUMBER CRD42022337434.
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Affiliation(s)
- Jonathan A Schulz
- Department of Psychiatry, Vermont Center on Behavior and Health, Burlington, Vermont, USA
| | - Gary S Atwood
- Dana Medical Library, University of Vermont, Burlington, Vermont, USA
| | - Sean D Regnier
- Department of Behavioral Science, University of Kentucky College of Medicine, Lexington, Kentucky, USA
| | - Lindsey C Mullis
- Human Development Institute, University of Kentucky, Lexington, Kentucky, USA
| | - Austin Nugent
- Human Development Institute, University of Kentucky, Lexington, Kentucky, USA
| | - Tyler G Erath
- Department of Psychiatry, Vermont Center on Behavior and Health, Burlington, Vermont, USA
| | - Andrea C Villanti
- Rutgers Center for Tobacco Studies, Rutgers University, New Brunswick, New Jersey, USA
- Department of Health Behavior, Society, and Policy, Rutgers School of Public Health, Piscataway, New Jersey, USA
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13
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Faulhaber JR, Baffoe-Bonnie AW, Oursler KK, Vasudeva SS. Update in Human Immunodeficiency Virus and Aging. Infect Dis Clin North Am 2023; 37:153-173. [PMID: 36805011 DOI: 10.1016/j.idc.2022.11.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
Effective and consistent antiretroviral therapy has enabled people with human immunodeficiency virus (HIV) (PWH) to survive longer than previously encountered earlier in the epidemic. Consequently, PWH are subject to the struggles and clinical conditions typically associated with aging. However, the aging process in PWH is not the same as for those who do not have HIV. There is a complex interplay of molecular, microbiologic, and pharmacologic factors that leads to accelerated aging in PWH; this leads to increased risk for certain age-related comorbidities requiring greater vigilance and interventions in routine care.
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Affiliation(s)
- Jason R Faulhaber
- Virginia Tech Carilion School of Medicine, Carilion Clinic, Division of Infectious Diseases, 213 McClanahan St SW, Roanoke, VA 24014, USA.
| | - Anthony W Baffoe-Bonnie
- Virginia Tech Carilion School of Medicine, Carilion Clinic, Division of Infectious Diseases, 213 McClanahan St SW, Roanoke, VA 24014, USA
| | - Krisann K Oursler
- Virginia Tech Carilion School of Medicine, VA Salem Healthcare System, 1970 Roanoke Boulevard Salem, VA 24153-6404, USA
| | - Shikha S Vasudeva
- Virginia Tech Carilion School of Medicine, VA Salem Healthcare System, 1970 Roanoke Boulevard Salem, VA 24153-6404, USA
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14
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Edwards S, Puljević C, Dean JA, Gilks C, Boyd MA, Baker P, Watts P, Howard C, Gartner CE. Tobacco Harm Reduction with Vaporised Nicotine (THRiVe): A Feasibility Trial of Nicotine Vaping Products for Smoking Cessation Among People Living with HIV. AIDS Behav 2023; 27:618-627. [PMID: 35869375 PMCID: PMC9908735 DOI: 10.1007/s10461-022-03797-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/13/2022] [Indexed: 11/29/2022]
Abstract
People living with HIV (PLHIV) have high rates of tobacco smoking. Nicotine vaping products (NVPs) may promote tobacco smoking cessation and/or harm reduction. This study aimed to trial the feasibility of NVPs for promoting tobacco smoking cessation among PLHIV. The Tobacco Harm Reduction with Vaporised Nicotine (THRiVe) study was a mixed-methods trial among 29 PLHIV who used tobacco daily. Participants trialled a 12-week intervention of NVPs. This study reports descriptive analyses of quantitative data on tobacco abstinence and associated adverse events. Short-term abstinence (7-day point prevalence; i.e., no tobacco use for 7 days) was achieved by 35% of participants at Week 12 and 31% reported short-term abstinence at Week 24. Sustained medium-term abstinence (8 weeks' abstinence) was achieved by 15% of participants at Week 12 and 31% at Week 24. Most adverse events were mild. NVPs may represent a feasible and potentially effective short-to-medium term tobacco smoking cessation aid and/or harm reduction strategy among PLHIV.
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Affiliation(s)
- Stephanie Edwards
- School of Public Health, The University of Queensland, Brisbane, Australia
| | - Cheneal Puljević
- School of Public Health, The University of Queensland, Brisbane, Australia ,Centre for Health Services Research, The University of Queensland, Brisbane, Australia
| | - Judith A. Dean
- School of Public Health, The University of Queensland, Brisbane, Australia
| | - Charles Gilks
- School of Public Health, The University of Queensland, Brisbane, Australia
| | - Mark A. Boyd
- Faculty of Health & Medical Sciences, University of Adelaide, Adelaide, Australia ,Northern Adelaide Local Health Network (NALHN), Adelaide, Australia ,Kirby Institute, University of New South Wales, Sydney, Australia
| | - Peter Baker
- School of Public Health, The University of Queensland, Brisbane, Australia
| | - Peter Watts
- Queensland Positive People, Brisbane, Australia
| | | | - Coral E. Gartner
- School of Public Health, The University of Queensland, Brisbane, Australia
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15
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Tamí-Maury I, Tundealao S, Guzman J, Noé-Díaz V, Markham C, Vigil K. Developing and pre-testing a digital decision-tree smartphone application for smoking prevention and cessation among HIV care providers. Digit Health 2023; 9:20552076231179029. [PMID: 37312958 PMCID: PMC10259109 DOI: 10.1177/20552076231179029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 05/12/2023] [Indexed: 06/15/2023] Open
Abstract
Objectives The diagnosis and continuous care of chronic conditions such as HIV infection present potential teachable moments for delivering smoking prevention and cessation interventions for patients. We designed and pre-tested a prototype of a smartphone application(app), Decision-T, specifically designed to assist healthcare providers when providing personalized smoking prevention and cessation services to their patients. Methods We developed the Decision-T app based on transtheoretical algorithm for smoking prevention and cessation following the 5-A's model. We employed a mixed-methods approach among 18 HIV-care providers recruited from Houston Metropolitan Area for pre-testing the app. Each provider participated in three mock sessions, and the average time spent at each session was measured. We measured accuracy by comparing the smoking prevention and cessation treatment offered by the HIV-care provider using the app to that chosen by the tobacco specialist who designed the case. The system usability scale (SUS) was used to assess usability quantitatively , while individual interview transcripts were analyzed to determine usability qualitatively. STATA-17/SE and Nvivo-V12 were used for quantitative and qualitative analysis, respectively. Results The average time for completing each mock session was 5 min 17 s. The participants achieved an overall average accuracy of 89.9%. The average SUS score achieved was 87.5(±10.26). After analyzing the transcripts, five themes (app's contents are beneficial and straightforward, design is easy to understand, user's experience is uncomplicated, tech is intuitive, and app needs improvements) emerged. Conclusions The decision-T app can potentially increase HIV-care providers' engagement in offering smoking prevention and cessation behavioral and pharmacotherapy recommendations to their patients briefly and accurately.
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Affiliation(s)
- Irene Tamí-Maury
- School of Public Health, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Samuel Tundealao
- School of Public Health, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Jenna Guzman
- School of Public Health, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Valeri Noé-Díaz
- Department of Psychology, Universidad Intercontinental, México City, Mexico
| | - Christine Markham
- School of Public Health, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Karen Vigil
- McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas, USA
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16
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Haas CB, Engels EA, Horner MJ, Freedman ND, Luo Q, Gershman S, Qiao B, Pfeiffer RM, Shiels MS. Trends and risk of lung cancer among people living with HIV in the USA: a population-based registry linkage study. Lancet HIV 2022; 9:e700-e708. [PMID: 36179753 PMCID: PMC9641618 DOI: 10.1016/s2352-3018(22)00219-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 07/19/2022] [Accepted: 07/21/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Lung cancer is a common cancer in people living with HIV, but the risk of cancer in this group has not been investigated for over a decade. We investigated trends in relative and absolute risk of lung cancer among people living with HIV of various age groups in the USA. METHODS In this population-based registry linkage study, we used 2001-16 data from the HIV/AIDS Cancer Match study, which links data from HIV and cancer registries from 13 regions in the USA. We included non-Hispanic White, non-Hispanic Black, and Hispanic individuals living with HIV aged 20-89 years in our study population. Average annual percentage changes in lung cancer rates were estimated with multivariable Poisson regression, and standardised incidence ratios (SIRs) and excess absolute risks were estimated comparing people living with HIV with the general US population. We used non-parametric cumulative incidence curves to estimate the 5-year cumulative incidence of lung cancer and two AIDS-defining cancers (non-Hodgkin lymphoma and Kaposi sarcoma). FINDINGS There were 3426 lung cancers in 4 310 304 person-years of follow-up in our study population. Age-standardised lung cancer incidence rates in people living with HIV declined by 6% per year (95% CI -7 to -5) during 2001-16, with greater declines in the 20-29 age group (-11%, -16 to 6) than in the older age groups (eg, -3% [-6 to 1] in those aged 70-89 years). During 2013-16, the SIR of lung cancer in people living with HIV was 2·01 (95% CI 1·52 to 2·61) in those aged 40-49 years, and 1·31 (1·12 to 1·52) in those aged 60-69 years, whereas the excess absolute risk among people living with HIV was 11·87 (3·95 to 21·89) per 100 000 person-years for those aged 40-49 years and 48·23 (6·88 to 95·47) per 100 000 person-years for those aged 60-69 years. Beginning in 2011, the 5-year cumulative incidence for lung cancer (1·36%, 95% CI 1·17 to 1·53) surpassed that of Kaposi sarcoma (0·12%, 0·06 to 0·17) and non-Hodgkin lymphoma (0·45%, 0·35 to 0·56) for people living with HIV aged 60-69 years. INTERPRETATION Between 2001 and 2016, the risk of lung cancer decreased for people living with HIV aged 20-69 years, but remained substantially elevated compared with the general population, probably due to a combination of smoking and immunosuppression. For people living with HIV aged 60 years and older, the risk of lung cancer exceeds that of two of the most common AIDS-defining cancers, highlighting the importance of lung cancer among the growing older population of people living with HIV. FUNDING Intramural Research Program of the US National Cancer Institute.
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Affiliation(s)
- Cameron B Haas
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institute of Health, Rockville, MD, USA.
| | - Eric A Engels
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institute of Health, Rockville, MD, USA
| | - Marie-Josèphe Horner
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institute of Health, Rockville, MD, USA
| | - Neal D Freedman
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institute of Health, Rockville, MD, USA
| | - Qianlai Luo
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institute of Health, Rockville, MD, USA
| | - Susan Gershman
- Office of Population Health, Office of Data Management and Outcomes Assessment, Massachusetts Cancer Registry, Massachusetts Department of Public Health, Boston, MA, USA
| | - Baozhen Qiao
- Bureau of Cancer Epidemiology, New York State Department of Health, Albany, New York, NY, USA
| | - Ruth M Pfeiffer
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institute of Health, Rockville, MD, USA
| | - Meredith S Shiels
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institute of Health, Rockville, MD, USA
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17
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Reddy KP, Kruse GR, Lee S, Shuter J, Rigotti NA. Tobacco Use and Treatment of Tobacco Dependence Among People With Human Immunodeficiency Virus: A Practical Guide for Clinicians. Clin Infect Dis 2022; 75:525-533. [PMID: 34979543 PMCID: PMC9427148 DOI: 10.1093/cid/ciab1069] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Indexed: 01/05/2023] Open
Abstract
More than 40% of people with human immunodeficiency virus (PWH) in the United States smoke tobacco cigarettes. Among those on antiretroviral therapy, smoking decreases life expectancy more than human immunodeficiency virus (HIV) itself. Most PWH who smoke want to quit, but tobacco dependence treatment has not been widely integrated into HIV care. This article summarizes the epidemiology of tobacco use among PWH, health consequences of tobacco use and benefits of cessation in PWH, and studies of treatment for tobacco dependence among the general population and among PWH. We provide practical guidance for providers to treat tobacco dependence among PWH. A 3-step Ask-Advise-Connect framework includes asking about tobacco use routinely during clinical encounters, advising about tobacco cessation with emphasis on the benefits of cessation, and actively connecting patients to cessation treatments, including prescription of pharmacotherapy (preferably varenicline) and direct connection to behavioral interventions via telephone quitline or other means to increase the likelihood of a successful quit attempt.
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Affiliation(s)
- Krishna P Reddy
- Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston, Massachusetts, USA
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, Massachusetts, USA
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Gina R Kruse
- Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Stephanie Lee
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Jonathan Shuter
- Department of Medicine and Department of Epidemiology and Population Health, Division of Infectious Diseases, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Nancy A Rigotti
- Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
- Mongan Institute for Health Policy, Massachusetts General Hospital, Boston, Massachusetts, USA
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18
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Asfar T, Alcaide ML, Jones DL, McClure LA, Brewer J, Lee DJ, Carrico A. HIV patients’ perceptions of a potential multi-component mindfulness-based smoking cessation smartphone application intervention. PLoS One 2022; 17:e0271946. [PMID: 36006893 PMCID: PMC9409537 DOI: 10.1371/journal.pone.0271946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 06/14/2022] [Indexed: 11/24/2022] Open
Abstract
Objectives Cigarette smoking rates among people living with HIV (PLWH) in the US is triple that of the general population. PLWH smokers are a high-risk group for smoking-related health disparities and should be a prime focus for smoking cessation efforts. Our team has developed a novel evidence-based Mindfulness Training (MT) smoking cessation smartphone application (app), “Craving-to-Quit.” Using qualitative focus groups among PLWH smokers, this study aims to tailor and optimize the app’s content and design to PLWH’s unique psychosocial profile and needs. Methods We conducted 8 focus groups among PLWH smokers (n = 59; 47.5% females; ≥18 years) to gain insight into participants’ perceptions about the app, MT, and the feasibility and acceptability of adding two additional strategies (CM: Contingency Management; self-monitoring of anti-retroviral therapies intake [ART]) to further optimize the app. Participants were asked to practice MTs and watch videos from the app presented on a screen in the conference room to discuss their experience. Sessions were audio-taped, transcribed verbatim, and analyzed thematically using NVivo. Results Most participants were non-Hispanic black (67.8%), on a federal health insurance program (61.0%). Participants considered it easy to learn the app and thought that MT is helpful in reducing stress and motivating quit attempts and were supportive of adding CM and recommended providing $20-$50 weekly cash incentives to help in quitting. Participants felt that adding self-monitoring of ART is helpful but were concerned about confidentiality in case they lost their phone. Participants recommended making the app cost-free and adding information about smoking cessation medications and the negative effects of smoking among PLWH. Conclusions Findings will guide the development of a novel multi-component smoking cessation intervention app integrating MT, CM, and ART self-monitoring strategies. This intervention has the potential to address several barriers to quitting in PLWH. Further clinical research is needed to test this intervention.
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Affiliation(s)
- Taghrid Asfar
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, United States of America
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, United States of America
- * E-mail:
| | - Maria Luisa Alcaide
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, United States of America
- Internal Medicine, Jackson Memorial Hospital, Miami, FL, United States of America
| | - Deborah L. Jones
- Department of Psychiatry & Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, United States of America
| | - Laura A. McClure
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, United States of America
| | - Judson Brewer
- Department of Behavioral and Social Sciences, Brown Mindfulness Center, Brown University School of Public Health, Providence, RI, United States of America
| | - David J. Lee
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, United States of America
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, United States of America
| | - Adam Carrico
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, United States of America
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19
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Schnall R, Liu J, Alvarez G, Porras T, Ganzhorn S, Boerner S, Huang MC, Trujillo P, Cioe P. A Smoking Cessation Mobile App for Persons Living With HIV: Preliminary Efficacy and Feasibility Study. JMIR Form Res 2022; 6:e28626. [PMID: 35980739 PMCID: PMC9437787 DOI: 10.2196/28626] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 06/07/2022] [Accepted: 06/24/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The prevalence of smoking in the United States general population has gradually declined to the lowest rate ever recorded; however, this has not been true for persons with HIV. OBJECTIVE We conducted a pilot test to assess the feasibility and efficacy of the Lumme Quit Smoking mobile app and smartwatch combination with sensing capabilities to improve smoking cessation in persons with HIV. METHODS A total of 40 participants were enrolled in the study and randomly assigned 1:1 to the control arm, which received an 8-week supply of nicotine replacement therapy, a 30-minute smoking cessation counseling session, and weekly check-in calls with study staff, or to the intervention arm, which additionally received the Lumme Quit Smoking app and smartwatch. RESULTS Of the 40 participants enrolled, 37 completed the follow-up study assessments and 16 used the app every day during the 56-day period. During the 6-month recruitment and enrollment period, 122 people were screened for eligibility, with 67.2% (82/122) deemed ineligible. Smoking criteria and incompatible tech were the major reasons for ineligibility. There was no difference in the proportion of 7-day point prevalence abstinence by study arm and no significant decrease in exhaled carbon monoxide for the intervention and control arms separately. However, the average exhaled carbon monoxide decreased over time when analyzing both arms together (P=.02). CONCLUSIONS Results suggest excellent feasibility and acceptability of using a smoking sensor app among this smoking population. The knowledge gained from this research will enable the scientific community, clinicians, and community stakeholders to improve tobacco cessation outcomes for persons with HIV. TRIAL REGISTRATION ClinicalTrials.gov NCT04808609; https://clinicaltrials.gov/ct2/show/NCT04808609.
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Affiliation(s)
- Rebecca Schnall
- Columbia University School of Nursing, New York, NY, United States
| | - Jianfang Liu
- Columbia University School of Nursing, New York, NY, United States
| | | | - Tiffany Porras
- Zucker School of Medicine, Hofstra University, Hempstead, NY, United States
| | - Sarah Ganzhorn
- Columbia University School of Nursing, New York, NY, United States
| | - Samantha Boerner
- Center for Psychedelic Medicine, Department of Psychiatry, NYU Langone Health, New York, NY, United States
- New York University Grossman School of Medicine, New York, NY, United States
- Bellevue Hospital Center, New York, NY, United States
| | - Ming-Chun Huang
- Case School of Engineering, Case Western Reserve University, Cleveland, OH, United States
| | - Paul Trujillo
- Columbia University School of Nursing, New York, NY, United States
| | - Patricia Cioe
- Center for Alcohol and Addiction Studies, Brown University, Providence, RI, United States
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20
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Bold KW, Deng Y, Dziura J, Porter E, Sigel KM, Yager JE, Ledgerwood DM, Bernstein SL, Edelman EJ. Practices, attitudes, and confidence related to tobacco treatment interventions in HIV clinics: a multisite cross-sectional survey. Transl Behav Med 2022; 12:726-733. [PMID: 35608982 PMCID: PMC9260059 DOI: 10.1093/tbm/ibac022] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Tobacco use disorder (TUD) is a major threat to health among people with HIV (PWH), but it is often untreated. Among HIV clinicians and staff, we sought to characterize practices, attitudes, and confidence addressing TUD among PWH to identify potential opportunities to enhance provision of care. Cross-sectional deidentified, web-based surveys were administered from November 4, 2020 through December 15, 2020 in HIV clinics in three health systems in the United States Northeast. Surveys assessed provider characteristics and experience, reported practices addressing tobacco use, and knowledge and attitudes regarding medications for TUD. Chi-square tests or Fisher's exact tests were used to examine differences in responses between clinicians and staff who were prescribers versus nonprescribers and to examine factors associated with frequency of prescribing TUD medications. Among 118 survey respondents (56% prescribers), only 50% reported receiving prior training on brief smoking cessation interventions. Examining reported practices identified gaps in the delivery of TUD care, including counseling patients on the impact of smoking on HIV, knowledge of clinical practice guidelines, and implementation of assessment and brief interventions for smoking. Among prescribers, first-line medications for TUD were infrequently prescribed and concerns about medication side effects and interaction with antiretroviral treatments were associated with low frequency of prescribing. HIV clinicians and staff reported addressable gaps in their knowledge, understanding, and practices related to tobacco treatment. Additional work is needed to identify ways to ensure adequate training for providers to enhance the delivery of TUD treatment in HIV clinic settings.
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Affiliation(s)
- Krysten W Bold
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Yanhong Deng
- Yale Center for Analytic Sciences, Yale School of Public Health, New Haven, CT, USA
| | - James Dziura
- Yale Center for Analytic Sciences, Yale School of Public Health, New Haven, CT, USA
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Elizabeth Porter
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Keith M Sigel
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jessica E Yager
- State University of New York Downstate Health Sciences University, Brooklyn, NY, USA
| | - David M Ledgerwood
- Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, MI, USA
| | - Steven L Bernstein
- Department of Emergency Medicine, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - E Jennifer Edelman
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
- Program in Addiction Medicine, Yale School of Medicine, New Haven, CT, USA
- Center for Interdisciplinary Research on AIDS, Yale School of Public Health, New Haven, CT, USA
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21
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Yang S, Huang J, Ye L, Lin J, Xie Z, Guo B, Li Y, Liang B, Zheng Z, Lunze K, Abdullah AS, Liang H, Quintiliani LM. Factors Related to Smoking and Perceptions of a Behavioral Counseling and Messenger Service-Delivered Smoking Cessation Intervention for People with HIV in China: A Qualitative Study (Preprint). JMIR Form Res 2022; 6:e35923. [PMID: 36222795 PMCID: PMC9607887 DOI: 10.2196/35923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 07/14/2022] [Accepted: 08/15/2022] [Indexed: 11/20/2022] Open
Abstract
Background China, where half of the adult male population smoke tobacco, has one of the highest global burdens of smoking. Smoking rates are even higher among people with HIV. People with HIV can be affected by smoking in multiple ways, including more severe HIV-related symptoms and worse antiretroviral therapy treatment outcomes. However, smoking cessation services targeted for people with HIV are not routinely integrated into HIV care in China. Given the widespread mobile phone ownership, an exploration of factors related to smoking among people with HIV in China who smoke could inform the design and implementation of mobile smoking cessation interventions that target the needs of this vulnerable population. Objective This study aims to explore the perspectives of smoking, barriers and facilitators to quitting, and perceptions related to a smoking cessation intervention delivered through behavioral counseling sessions and brief daily messenger service (WeChat)–delivered messages. Methods We recruited people with HIV from the People’s 4th Hospital of Nanning, Guangxi, China, and conducted semistructured face-to-face interviews. All interviews were audio-recorded, transcribed verbatim in Chinese, and translated into English for data analysis. We conducted a thematic analysis using a codebook, which was guided by a team-based consensus approach to identify 5 main themes. We also explored themes according to the demographic groups. Results A total of 24 participants were enrolled in the study. The mean age was 37.2 (SD=13.5) years. The participants had lived with HIV for a mean of 2.4 years. The majority were male (18/24, 75%) and lived in urban or metropolitan settings (19/24, 79%). We identified five main themes: variable knowledge of the harms of smoking, both related and unrelated to HIV; willpower perceived as the primary quitting strategy; a duality of the effect of social factors on quitting; perceptions about optimal features of the smoking cessation intervention (eg, messages should be brief and most frequent during the first few weeks); and the largely negative impact of their HIV diagnosis on smoking behaviors. In addition, some themes differed according to participant demographic characteristics such as age, sex, and education level. Conclusions We identified barriers to and facilitators of smoking cessation among people with HIV in China by conducting semistructured qualitative interviews. Owing to the adverse impact of smoking on HIV outcomes, targeting cessation interventions to the unique needs and preferences of people with HIV in China may be needed to increase the effectiveness of future interventions. A pilot clinical trial will be conducted in the future to evaluate this behavioral counseling and brief daily messenger service (WeChat)–delivered messages approach among people with HIV who smoke in China.
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Affiliation(s)
- Shanyin Yang
- Section of General Internal Medicine, Boston Medical Center, Boston, MA, United States
| | - Jiegang Huang
- Guangxi Key Laboratory of AIDS Prevention and Treatment, School of Public Health, Guangxi Medical University, Nanning, Guangxi, China
| | - Li Ye
- Guangxi Key Laboratory of AIDS Prevention and Treatment, School of Public Health, Guangxi Medical University, Nanning, Guangxi, China
- Collaborative Innovation Centre of Regenerative Medicine and Medical BioResource Development and Application Co-constructed by the Province and Ministry, Nanning, Guangxi, China
| | - Jianyan Lin
- The Fourth People's Hospital of Nanning, Nanning, Guangxi, China
| | - Zhiman Xie
- The Fourth People's Hospital of Nanning, Nanning, Guangxi, China
| | - Baodong Guo
- Guangxi Key Laboratory of AIDS Prevention and Treatment, School of Public Health, Guangxi Medical University, Nanning, Guangxi, China
| | - Yanjun Li
- The Fourth People's Hospital of Nanning, Nanning, Guangxi, China
| | - Bingyu Liang
- Guangxi Key Laboratory of AIDS Prevention and Treatment, School of Public Health, Guangxi Medical University, Nanning, Guangxi, China
- Collaborative Innovation Centre of Regenerative Medicine and Medical BioResource Development and Application Co-constructed by the Province and Ministry, Nanning, Guangxi, China
| | - Zhigang Zheng
- Guangxi Key Laboratory of AIDS Prevention and Treatment, School of Public Health, Guangxi Medical University, Nanning, Guangxi, China
| | - Karsten Lunze
- Section of General Internal Medicine, Boston Medical Center, Boston, MA, United States
- Department of Medicine, Boston Univeristy School of Medicine, Boston, MA, United States
| | - Abu S Abdullah
- Department of Medicine, Boston Univeristy School of Medicine, Boston, MA, United States
| | - Hao Liang
- Guangxi Key Laboratory of AIDS Prevention and Treatment, School of Public Health, Guangxi Medical University, Nanning, Guangxi, China
- Collaborative Innovation Centre of Regenerative Medicine and Medical BioResource Development and Application Co-constructed by the Province and Ministry, Nanning, Guangxi, China
- Life Science Institute, Guangxi Medical University, Nanning, Guangxi, China
| | - Lisa M Quintiliani
- Section of General Internal Medicine, Boston Medical Center, Boston, MA, United States
- Department of Medicine, Boston Univeristy School of Medicine, Boston, MA, United States
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22
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Liang HJ, Ernst T, Cunningham E, Chang L. Contributions of chronic tobacco smoking to HIV-associated brain atrophy and cognitive deficits. AIDS 2022; 36:513-524. [PMID: 34860196 PMCID: PMC8881356 DOI: 10.1097/qad.0000000000003138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Tobacco smoking is linked to cognitive deficits and greater white matter (WM) abnormalities in people with HIV disease (PWH). Whether tobacco smoking additionally contributes to brain atrophy in PWH is unknown and was evaluated in this study. DESIGN We used a 2 × 2 design that included 83 PWH (43 nonsmokers, 40 smokers) and 171 HIV-seronegative (SN, 106 nonsmokers, 65 smokers) participants and assessed their brain structure and cognitive function. METHODS Selected subcortical volumes, voxel-wise cortical volumes and thickness, and total WM volume were analyzed using FreeSurfer. Independent and interactive effects of HIV and smoking were evaluated with two-way analysis of covariance on cognitive domain Z-scores and morphometric measures on T1-weighted MRI. RESULTS Regardless of smoking status, relative to SN, PWH had smaller brain volumes [basal ganglia, thalami, hippocampi, subcortical gray matter (GM) and cerebral WM volumes (P = 0.002-0.042)], steeper age-related declines in the right superior-parietal (interaction: P < 0.001) volumes, and poorer attention/working memory and learning (P = 0.016-0.027). Regardless of HIV serostatus, smokers tended to have smaller hippocampi than nonsmokers (-0.6%, P = 0.055). PWH smokers had the smallest total and regional subcortical GM and cortical WM volume and poorest cognitive performance. CONCLUSIONS Tobacco smoking additionally contributed to brain atrophy and cognitive deficits in PWH. The greater brain atrophy in PWH smokers may be due to greater neuronal damage or myelin loss in various brain regions, leading to their poor cognitive performance. Therefore, tobacco smoking may exacerbate or increase the risk for HIV-associated neurocognitive disorders.
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Affiliation(s)
- Hua-Jun Liang
- Department of Diagnostic Radiology and Nuclear Medicine,
University of Maryland School of Medicine, Baltimore, MD, USA
| | - Thomas Ernst
- Department of Diagnostic Radiology and Nuclear Medicine,
University of Maryland School of Medicine, Baltimore, MD, USA
- Department of Neurology, Johns Hopkins University School of
Medicine, Baltimore, MD, USA
| | - Eric Cunningham
- Department of Diagnostic Radiology and Nuclear Medicine,
University of Maryland School of Medicine, Baltimore, MD, USA
| | - Linda Chang
- Department of Diagnostic Radiology and Nuclear Medicine,
University of Maryland School of Medicine, Baltimore, MD, USA
- Department of Neurology, Johns Hopkins University School of
Medicine, Baltimore, MD, USA
- Department of Neurology, University of Maryland School of
Medicine, Baltimore, MD, USA
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23
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Lopez W, Sayles H, Bares SH, Fadul N. Low Rates of Lung Cancer Screening Referrals in Patients With Human Immunodeficiency Virus: A Correlational Study. Cancer Control 2022; 29:10732748221103624. [PMID: 35591798 PMCID: PMC9125047 DOI: 10.1177/10732748221103624] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
People living with HIV (PLWH) have an increased risk of lung cancer compared to the general population. In 2013, the United States Preventive Services Task Force (USPSTF) released their lung cancer screening (LCS) guidelines. However, the impact of these guidelines has not been well established in PLWH. The objective of this retrospective descriptive study is to evaluate the frequency of lung cancer screening referrals and factors associated with LCS referrals using the 2013 USPSTF screening guidelines in at-risk PLWH. We collected demographic and clinical information on PLWH from electronic medical records from July 2016 to July 2018. Descriptive statistics, chi-square tests, t-tests, Wilcoxon rank sum tests, and Fisher’s exact tests were used for analysis. Only 14% of patients who met 2013 USPSTF screening guidelines were referred for screening. Patients who received a referral were more likely to have received tobacco cessation counseling. Patients who received and completed a referral were more likely to have hepatitis C infection. Quality improvement strategies are needed to improve rates of LCS in PLWH.
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Affiliation(s)
- Wilfredo Lopez
- Division of Infectious Diseases, 12284University of Nebraska Medical Center, Omaha, NE, USA
| | - Harlan Sayles
- College of Public Health, 12284University of Nebraska Medical Center, Omaha, NE, USA
| | - Sara H Bares
- Division of Infectious Diseases, 12284University of Nebraska Medical Center, Omaha, NE, USA
| | - Nada Fadul
- Division of Infectious Diseases, 12284University of Nebraska Medical Center, Omaha, NE, USA
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24
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Thompson MA, Horberg MA, Agwu AL, Colasanti JA, Jain MK, Short WR, Singh T, Aberg JA. Erratum to: Primary Care Guidance for Persons With Human Immunodeficiency Virus: 2020 Update by the HIV Medicine Association of the Infectious Diseases Society of America. Clin Infect Dis 2021; 74:1893-1898. [PMID: 34878522 DOI: 10.1093/cid/ciab801] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Affiliation(s)
| | - Michael A Horberg
- Mid-Atlantic Permanente Research Institute, Kaiser Permanente Mid-Atlantic Permanente Medical Group, Rockville, Maryland, USA
| | - Allison L Agwu
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | | | - Mamta K Jain
- Division of Infectious Diseases, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - William R Short
- Division of Infectious Diseases, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Tulika Singh
- Internal Medicine, HIV and Infectious Disease, Desert AIDS Project, Palm Springs, California, USA
| | - Judith A Aberg
- Division of Infectious Diseases, Mount Sinai Health System, New York, New York, USA
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25
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Vidrine DJ, Bui TC, Businelle MS, Shih YCT, Sutton SK, Shahani L, Hoover DS, Bowles K, Vidrine JI. Evaluating the Efficacy of Automated Smoking Treatment for People With HIV: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2021; 10:e33183. [PMID: 34787590 PMCID: PMC8663670 DOI: 10.2196/33183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 09/03/2021] [Indexed: 11/29/2022] Open
Abstract
Background Smoking prevalence rates among people with HIV are nearly 3 times higher than those in the general population. Nevertheless, few smoking cessation trials targeting smokers with HIV have been reported in the literature. Efforts to develop and evaluate sustainable, low-cost, and evidence-based cessation interventions for people with HIV are needed. Given the widespread proliferation of mobile phones, the potential of using mobile health apps to improve the reach and efficacy of cessation interventions is promising, but evidence of efficacy is lacking, particularly among people with HIV. Objective This study will consist of a 2-group randomized controlled trial to evaluate a fully automated smartphone intervention for people with HIV seeking cessation treatment. Methods Participants (N=500) will be randomized to receive either standard treatment (ST; 250/500, 50%) or automated treatment (AT; 250/500, 50%). ST participants will be connected to the Florida Quitline and will receive nicotine replacement therapy in the form of transdermal patches and lozenges. This approach, referred to as Ask Advise Connect, was developed by our team and has been implemented in numerous health systems. ST will be compared with AT, a fully automated behavioral treatment approach. AT participants will receive nicotine replacement therapy and an interactive smartphone-based intervention that comprises individually tailored audiovisual and text content. The major goal is to determine whether AT performs better in terms of facilitating long-term smoking abstinence than the more resource-intensive ST approach. Our primary aim is to evaluate the efficacy of AT in facilitating smoking cessation among people with HIV. As a secondary aim, we will explore potential mediators and moderators and conduct economic evaluations to assess the cost and cost-effectiveness of AT compared with ST. Results The intervention content has been developed and finalized. Recruitment and enrollment will begin in the fall of 2021. Conclusions There is a critical need for efficacious, cost-effective, and sustainable cessation treatments for people with HIV who smoke. The AT intervention was designed to help fill this need. If efficacy is established, the AT approach will be readily adoptable by HIV clinics and community-based organizations, and it will offer an efficient way to allocate limited public health resources to tobacco control interventions. Trial Registration ClinicalTrials.gov NCT05014282; https://clinicaltrials.gov/ct2/show/NCT05014282 International Registered Report Identifier (IRRID) PRR1-10.2196/33183
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Affiliation(s)
- Damon J Vidrine
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, United States
| | - Thanh C Bui
- Stephenson Cancer Center, TSET Health Promotion Research Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Michael S Businelle
- Stephenson Cancer Center, TSET Health Promotion Research Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Ya-Chen Tina Shih
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Steven K Sutton
- Department of Biostatistics and Bioinformatics, Moffitt Cancer Center, Tampa, FL, United States
| | - Lokesh Shahani
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | | | - Kristina Bowles
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, United States
| | - Jennifer I Vidrine
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, United States
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26
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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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27
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Cioe PA, Pinkston M, Tashima KT, Kahler CW. Peer navigation for smoking cessation in smokers with HIV: Protocol for a randomized clinical trial. Contemp Clin Trials 2021; 110:106435. [PMID: 33992767 PMCID: PMC8590703 DOI: 10.1016/j.cct.2021.106435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 05/07/2021] [Accepted: 05/10/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Smoking prevalence in persons with HIV (PWH) is high (40%) and cessation rates remain low. Lack of social support and poor adherence to nicotine replacement therapy (NRT) are related to poor cessation outcomes; thus, both factors represent possible targets for smoking cessation interventions. Peer navigators (PNs) have been integrated into HIV care with great success to improve engagement and adherence to antiretroviral therapy. However, no clinical trial has evaluated the potential for PNs to provide social support and improve NRT adherence for smoking cessation. We developed a treatment protocol that targets social support, adherence, and self-efficacy for quitting by incorporating PNs into a smoking cessation program. This randomized trial will test whether this approach results in higher rates of 7-day point prevalence abstinence at 12- and 24-weeks, compared to standard treatment. METHODS Seventy-two smokers with HIV will be randomized to either Peer Navigation Social Support for smoking cessation (PNSS-S) or standard cessation counseling. All participants will meet with a nurse for a smoking cessation counseling session, which will include discussion of FDA-approved cessation pharmacotherapy. Participants assigned to PNSS-S will receive weekly phone calls from the PN for 12 weeks. The PN will address readiness to quit, using medication to quit, common barriers to cessation, high risk situations, slip management, and maintaining abstinence. Smoking cessation outcomes will be measured at 4, 12, and 24 weeks following the baseline appointment. CONCLUSION Results from this study will provide preliminary evidence of whether incorporating a peer navigator-based intervention into smoking cessation treatment can improve smoking cessation outcomes in PWH.
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Affiliation(s)
- Patricia A Cioe
- Center for Alcohol and Addiction Studies, Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, United States of America.
| | - Megan Pinkston
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, United States of America; Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI, United States of America
| | - Karen T Tashima
- Division of Infectious Diseases, Alpert Medical School of Brown University, Providence, RI, United States of America
| | - Christopher W Kahler
- Center for Alcohol and Addiction Studies, Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, United States of America
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28
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Edelman EJ, Dziura J, Deng Y, Bold KW, Murphy SM, Porter E, Sigel KM, Yager JE, Ledgerwood DM, Bernstein SL. A SMARTTT approach to Treating Tobacco use disorder in persons with HIV (SMARTTT): Rationale and design for a hybrid type 1 effectiveness-implementation study. Contemp Clin Trials 2021; 110:106379. [PMID: 33794354 PMCID: PMC8478961 DOI: 10.1016/j.cct.2021.106379] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 02/19/2021] [Accepted: 03/26/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Tobacco use disorder is a leading threat to the health of persons with HIV (PWH) on antiretroviral treatment and identifying optimal treatment approaches to promote abstinence is critical. We describe the rationale, aims, and design for a new study, "A SMART Approach to Treating Tobacco Use Disorder in Persons with HIV (SMARTTT)," a sequential multiple assignment randomized trial. METHODS In HIV clinics within three health systems in the northeastern United States, PWH with tobacco use disorder are randomized to nicotine replacement therapy (NRT) with or without contingency management (NRT vs. NRT + CM). Participants with response (defined as exhaled carbon monoxide (eCO)-confirmed smoking abstinence at week 12), continue the same treatment for another 12 weeks. Participants with non-response, are re-randomized to either switch medications from NRT to varenicline or intensify treatment to a higher CM reward schedule. Interventions are delivered by clinical pharmacists embedded in HIV clinics. The primary outcome is eCO-confirmed smoking abstinence; secondary outcomes include CD4 cell count, HIV viral load suppression, and the Veterans Aging Cohort Study (VACS) Index 2.0 score (a validated measure of morbidity and mortality based on laboratory data). Consistent with a hybrid type 1 effectiveness-implementation design and grounded in implementation science frameworks, we will conduct an implementation-focused process evaluation in parallel. Study protocol adaptations related to the COVID-19 pandemic have been made. CONCLUSIONS SMARTTT is expected to generate novel findings regarding the impact, cost, and implementation of an adaptive clinical pharmacist-delivered intervention involving medications and CM to promote smoking abstinence among PWH. ClinicalTrials.govidentifier:NCT04490057.
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Affiliation(s)
- E Jennifer Edelman
- Program in Addiction Medicine, Yale School of Medicine, New Haven, CT, United States of America; Department of Internal Medicine, Yale School of Medicine, New Haven, CT, United States of America; Center for Interdisciplinary Research on AIDS, Yale School of Public Health, New Haven, CT, United States of America.
| | - James Dziura
- Yale Center for Analytic Sciences, Yale School of Public Health, New Haven, CT, United States of America; Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, United States of America
| | - Yanhong Deng
- Yale Center for Analytic Sciences, Yale School of Public Health, New Haven, CT, United States of America
| | - Krysten W Bold
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States of America
| | - Sean M Murphy
- CHERISH Center, Weill Cornell Medicine, New York, NY, United States of America
| | - Elizabeth Porter
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, United States of America
| | - Keith M Sigel
- Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Jessica E Yager
- State University of New York Downstate Health Sciences University, Brooklyn, NY, United States of America
| | - David M Ledgerwood
- Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, MI, United States of America
| | - Steven L Bernstein
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, United States of America; Yale Center for Implementation Science, Yale School of Medicine, New Haven, CT, United States of America
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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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Kaufman A, Ciccolo JT, Berzon RA, Edelman EJ. Preface to special collection of articles on interventions for promoting smoking cessation among individuals with HIV. Contemp Clin Trials 2021; 110:106518. [PMID: 34400363 DOI: 10.1016/j.cct.2021.106518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 07/23/2021] [Indexed: 11/20/2022]
Affiliation(s)
- Annette Kaufman
- Tobacco Control Research Branch, Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, 9609 Medical Center Dr, Rockville, MD 20850, United States of America.
| | - Joseph T Ciccolo
- Tobacco Control Research Branch, Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, 9609 Medical Center Dr, Rockville, MD 20850, United States of America.
| | - Rick A Berzon
- Division of Clinical and Health Services Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, 6707 Democracy Blvd., Suite 800, Bethesda, MD 20892, United States of America.
| | - E Jennifer Edelman
- Yale Schools of Medicine and Public Health, 367 Cedar Street, ES Harkness 401, New Haven, CT 06510, United States of America.
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Kim SS, Lee SA, Mejia J, Cooley ME, Demarco RF. Pilot Randomized Controlled Trial of a Digital Storytelling Intervention for Smoking Cessation in Women Living With HIV. Ann Behav Med 2021; 54:447-454. [PMID: 31863582 DOI: 10.1093/abm/kaz062] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND People living with HIV in the USA smoke at a rate nearly three times that of the general population, and Black women are disproportionately affected by HIV infection. PURPOSE This study was conducted to test the preliminary efficacy of a digital storytelling intervention for smoking cessation in U.S. women living with HIV. METHODS Participants in the treatment arm viewed a film in which women living with HIV talk about quitting smoking, and those in the control arm viewed an attention-control film in which women talk about living with HIV infection. Participants in both arms received eight weekly video-call counseling sessions focused on smoking cessation and nicotine patches or gum during the same period. Participants were followed on a monthly basis from quit day for 3 months. RESULTS Of the 53 participants randomized, four withdrew before receiving any intervention, one dropped out during the intervention, and 48 (90.6%) completed the study. No difference was found in the baseline characteristics between the two arms with the exception that the treatment arm had higher nicotine dependence scores [t(1.51) = 2.30, p = .03] than the control arm. Seven day point-prevalence abstinence rates at 3 month follow-up were not found to differ between the two arms. However, the odds of achieving 3 month prolonged abstinence were four times greater (odds ratio = 4.23, 95% confidence interval = 1.10, 16.23) in the treatment arm than the control arm when the analysis was performed with those (n = 49, 92.5%) who received any part of the allotted intervention. CONCLUSIONS A digital storytelling intervention seems to be a valuable strategy to enhance the effect of conventional tobacco dependence treatment for women living with HIV. However, the underlying mechanism of the effect of digital storytelling necessitates further investigations in a large RCT.Clinical Trials Registration No. NCT03289676.
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Affiliation(s)
- Sun S Kim
- Department of Nursing, College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, MA, USA
| | - Sang A Lee
- Department of Nursing, College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, MA, USA
| | - Jeannette Mejia
- Department of Psychology, College of Liberal Arts and Sciences, University of Florida, Gainesville, FL, USA
| | - Mary E Cooley
- Phyllis F. Cantor Center, Research in Nursing and Patient Care Services, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Rosanna F Demarco
- Department of Nursing, College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, MA, USA
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Webel AR, Schexnayder J, Cioe PA, Zuñiga JA. A Review of Chronic Comorbidities in Adults Living With HIV: State of the Science. J Assoc Nurses AIDS Care 2021; 32:322-346. [PMID: 33595986 PMCID: PMC8815414 DOI: 10.1097/jnc.0000000000000240] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
ABSTRACT People living with HIV are living longer, high-quality lives; however, as they age, this population is at increased risk for developing chronic comorbidities, including cardiovascular disease, certain types of cancer (e.g., lung, anal, and liver), and diabetes mellitus. The purpose of this state-of-the-science review is to provide an evidence-based summary on common physical comorbidities experienced by people living and aging with HIV. We focus on those chronic conditions that are prevalent and growing and share behavioral risk factors that are common in people living with HIV. We will discuss the current evidence on the epidemiology, physiology, prevention strategies, screening, and treatment options for people living with HIV across resource settings.
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Affiliation(s)
- Allison R Webel
- Allison R. Webel, PhD, RN, FAAN, is Associate Professor of Nursing, Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio, USA, and Associate Editor, Journal of the Association of Nurses in AIDS Care
- Julie Schexnayder, DNP, MPH, ACNP-BC, is a PhD Candidate, Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio, USA
- Patricia A. Cioe, PhD, RN, is Associate Professor of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, Rhode Island, USA
- Julie A. Zuñiga, RN, PhD, FAAN, is Assistant Professor of Nursing, School of Nursing, University of Texas at Austin, Austin, Texas, USA
| | - Julie Schexnayder
- Allison R. Webel, PhD, RN, FAAN, is Associate Professor of Nursing, Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio, USA, and Associate Editor, Journal of the Association of Nurses in AIDS Care
- Julie Schexnayder, DNP, MPH, ACNP-BC, is a PhD Candidate, Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio, USA
- Patricia A. Cioe, PhD, RN, is Associate Professor of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, Rhode Island, USA
- Julie A. Zuñiga, RN, PhD, FAAN, is Assistant Professor of Nursing, School of Nursing, University of Texas at Austin, Austin, Texas, USA
| | - Patricia A Cioe
- Allison R. Webel, PhD, RN, FAAN, is Associate Professor of Nursing, Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio, USA, and Associate Editor, Journal of the Association of Nurses in AIDS Care
- Julie Schexnayder, DNP, MPH, ACNP-BC, is a PhD Candidate, Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio, USA
- Patricia A. Cioe, PhD, RN, is Associate Professor of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, Rhode Island, USA
- Julie A. Zuñiga, RN, PhD, FAAN, is Assistant Professor of Nursing, School of Nursing, University of Texas at Austin, Austin, Texas, USA
| | - Julie A Zuñiga
- Allison R. Webel, PhD, RN, FAAN, is Associate Professor of Nursing, Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio, USA, and Associate Editor, Journal of the Association of Nurses in AIDS Care
- Julie Schexnayder, DNP, MPH, ACNP-BC, is a PhD Candidate, Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio, USA
- Patricia A. Cioe, PhD, RN, is Associate Professor of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, Rhode Island, USA
- Julie A. Zuñiga, RN, PhD, FAAN, is Assistant Professor of Nursing, School of Nursing, University of Texas at Austin, Austin, Texas, USA
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Rationale and design of a randomized factorial clinical trial of pharmacogenetic and adherence optimization strategies to promote tobacco cessation among persons with HIV. Contemp Clin Trials 2021; 110:106410. [PMID: 33901574 DOI: 10.1016/j.cct.2021.106410] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 04/16/2021] [Accepted: 04/19/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Tobacco use is approximately three times more common in people living with HIV (PLWH) than the general population. Moreover, current behavioral and pharmacological smoking cessation interventions are less effective for PLWH, highlighting a need for novel ways to optimize tobacco cessation treatments in this group. Prior research indicates that personalized treatment based on the nicotine metabolite ratio (NMR), a biomarker of nicotine metabolism, and augmenting smoking cessation medication adherence may improve cessation treatment for PLWH. METHODS In this 2 × 2 factorial design trial, 488 smokers with HIV receive 12 weeks of smoking cessation medication along with randomization to 1) tailor the smoking cessation drug to their metabolism or not, and 2) provide additional counseling on smoking cessation medication adherence or not. Those randomized to the pharmacogenetic optimization arm receive varenicline or the nicotine patch based on their NMR (varenicline for fast metabolizers and the nicotine patch for slow metabolizers) and those in the control arm receive varenicline. Those randomized to the experimental adherence counseling arm receive Managed Problem Solving (MAPS) targeting their smoking cessation medication and those in the control arm receive standard counseling. CONCLUSION PLWH on suppressive antiretroviral therapy who smoke lose more life-years due to tobacco use than to their HIV infection, and have lower response rates to current evidence-based treatments for smoking cessation. Both the NMR tailoring and MAPS interventions have the potential to optimize treatments for tobacco use among this population. If effective, this trial may demonstrate ways to further improve long-term health outcomes for PLWH.
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Asfar T, Perez A, Shipman P, Carrico AW, Lee DJ, Alcaide ML, Jones DL, Brewer J, Koru-Sengul T. National Estimates of Prevalence, Time-Trend, and Correlates of Smoking in US People Living with HIV (NHANES 1999-2016). Nicotine Tob Res 2021; 23:1308-1317. [PMID: 33856483 DOI: 10.1093/ntr/ntaa277] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 01/02/2021] [Indexed: 01/01/2023]
Abstract
OBJECTIVE Approximately one in four deaths among people living with HIV (PLWH) in the United States can be attributed to cigarette smoking. Using a nationally representative sample of PLWH, this study examines the prevalence, time-trends, and correlates of current cigarette smoking among PLWH compared to people without HIV. DESIGN Secondary analysis of population-based cross-sectional biobehavioral survey. METHODS Data were pooled from the 1999-2016 National Health and Nutrition Examination Survey (NHANES). All adults (20-59 years) who self-reported their smoking status and were tested for HIV (HIV+ = 152; HIV- = 26 305) were included in the analysis. Prevalence with 95% confidence interval (95% CI), trend analysis by year and group (HIV+/HIV-), and multivariable logistic regression analyses were performed with the complex survey design adjustments. RESULTS Overall, 47.0% of PLWH were current smokers compared to 25.5% of those without HIV. From 1999 to 2016, the decline in smoking in PLWH was comparable to those without HIV (10.7% vs. 8.0%). PLWH smokers were more likely than PLWH nonsmokers to be substance users (adjusted odds ratio [aOR] = 17.52; 95% CI = 2.04 to 27.8). Compared to smokers without HIV, PLWH smokers were more likely to be older (1.10; 1.06 to 1.14), males (7.96; 2.50 to 25.40), non-Hispanic Black (10.45; 4.13 to 26.45), with depression (Patient Health Questionnaire-9 sum score ≥5) (3.79; 1.22 to 11.79), and less likely to be gay (0.02; 0.00 to 0.07). CONCLUSION Cigarette smoking among PLWH is a major public health problem in the United States. Targeted and tailored smoking cessation interventions that incorporate assessment and treatment of depression and co-occurring substance use are critical for PLWH, especially among those who are disproportionately affected by smoking and HIV (sexual minority). IMPLICATIONS This study offers important research implications in four areas:1. The decline in smoking among PLWH over 18 years has been modest, and half of PLWH are still smokers.2. More resources and efforts should be allocated to reduce cigarette smoking among PLWH.3. There is a critical need to develop and test culturally tailored smoking cessation interventions for minority subgroups who are most impacted by HIV infection and smoking (non-Hispanic Blacks and men who have sex with men)4. Smoking cessation interventions designed for PLWH should incorporate assessment and treatment of depression and substance use.
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Affiliation(s)
- Taghrid Asfar
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA.,Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Amanda Perez
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Patrick Shipman
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Adam W Carrico
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - David J Lee
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA.,Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Maria Luisa Alcaide
- Division of Infectious Diseases at Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA.,Internal Medicine, Jackson Memorial Hospital, University of Miami, Miami, FL, USA
| | - Deborah L Jones
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Judson Brewer
- Mindfulness Center, Brown University School of Public Health and Warren Alpert School of Medicine, Providence, RI, USA
| | - Tulay Koru-Sengul
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA.,Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
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Borran M, Dashti-Khavidaki S, Khalili H. The need for an integrated pharmacological response to the treatment of HIV/AIDS and depression. Expert Opin Pharmacother 2021; 22:1179-1192. [PMID: 33586560 DOI: 10.1080/14656566.2021.1882419] [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: 10/22/2022]
Abstract
Introduction: The coexistence of depression and HIV infection affects more than 9 million people worldwide. A literature review revealed a large gap regarding the pharmacotherapy of depression among patients dually diagnosed with HIV and depression.Areas covered:In this review, the authors covered the various dimensions of deploying integrated pharmacological treatment of HIV/AIDS and depression. This topic was addressed in two ways; first, the direct results of integrated pharmacotherapy in syndemic patients; second, the indirect effects of the integrated model on other outcomes of HIV care.Expert opinion: An integrated pharmacological response to the treatment of HIV and depression can bring substantial benefits to HIV outcomes and reduce the burden of both diseases. The direct advantages regarding pharmacological response to the treatment of depression along with HIV care are improving adherence to antiretroviral therapy, optimizing pharmacotherapy, minimizing drug interaction, and prevention of additive adverse drug reactions. Furthermore, in some cases, medication can target both depression and other neuropsychiatric or somatic comorbidities among people living with HIV/AIDS. The integrated pharmacotherapy also has some potential indirect advantages on HIV care outcomes like minimizing loss of care, reducing ongoing HIV transmission, and improving the outcomes of both diseases.
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Affiliation(s)
- Mina Borran
- Department of Internal Medicine, School of Medicine, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Simin Dashti-Khavidaki
- Professor of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Hossein Khalili
- Professor of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
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Ashare RL, Bernstein SL, Schnoll R, Gross R, Catz SL, Cioe P, Crothers K, Hitsman B, Marhefka SL, McClure JB, Pacek LR, Vidrine DJ, Vilardaga R, Kaufman A, Edelman EJ. The United States National Cancer Institute's Coordinated Research Effort on Tobacco Use as a Major Cause of Morbidity and Mortality among People with HIV. Nicotine Tob Res 2021; 23:407-410. [PMID: 32803251 PMCID: PMC7454816 DOI: 10.1093/ntr/ntaa155] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 08/12/2020] [Indexed: 02/07/2023]
Abstract
The use of antiretroviral therapy for people with HIV (PWH) has improved life expectancy. However, PWH now lose more life-years to tobacco use than to HIV infection. Unfortunately, PWH smoke at higher rates and have more difficulty maintaining abstinence than the general population, compounding their risk for chronic disease. In this Commentary, we describe a United States National Cancer Institute-led initiative to address the relative lack of research focused on developing, testing, and implementing smoking cessation interventions for PWH. This initiative supports seven clinical trials designed to systematically test and/or develop and test adaptations of evidence-based smoking cessation interventions for PWH (eg, combination of behavioral and pharmacological). We summarize each project, including setting/recruitment sites, inclusion/exclusion criteria, interventions being tested, and outcomes. This initiative provides critical opportunities for collaboration and data harmonization across projects. The knowledge gained will inform strategies to assist PWH to promote and maintain abstinence, and ensure that these efforts are adaptable and scalable, thereby addressing one of the major threats to the health of PWH. Reducing smoking behavior may be particularly important during the COVID-19 pandemic given that smokers who become infected with SARS-CoV-2 may be at risk for more severe disease. IMPLICATIONS This Commentary describes a National Cancer Institute-led initiative to advance the science and practice of treating tobacco use among PWH, which is now responsible for more life years lost than HIV. We describe the scope of the problem, the objectives of the initiative, and a summary of the seven funded studies. Harmonization of data across projects will provide information related to treatment mediators and moderators that was not previously possible. Stakeholders interested in tobacco cessation, including researchers, clinicians and public health officials, should be aware of this initiative and the evidence-base it will generate to advance tobacco treatment among this high-risk population.
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Affiliation(s)
- Rebecca L Ashare
- Department of Psychiatry and Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Steven L Bernstein
- Department of Emergency Medicine, Yale Center for Implementation Science, Yale School of Medicine, New Haven, CT
| | - Robert Schnoll
- Department of Psychiatry and Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Robert Gross
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA
- Division of Infectious Diseases, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Sheryl L Catz
- Betty Irene Moore School of Nursing, University of California Davis, Sacramento, CA
| | - Patricia Cioe
- Center for Alcohol & Addiction Studies, Department of Behavioral & Social Sciences, Brown University School of Public Health, Providence, RI
| | - Kristina Crothers
- Veterans Affairs (VA) Puget Sound Health Care System and University of Washington School of Medicine, Seattle, WA
| | - Brian Hitsman
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Stephanie L Marhefka
- College of Public Health and Division of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa, FL
| | | | - Lauren R Pacek
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC
| | - Damon J Vidrine
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL
| | - Roger Vilardaga
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC
| | - Annette Kaufman
- Tobacco Control Research Branch, Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD
| | - E Jennifer Edelman
- Yale School of Medicine, New Haven, CT and Center for Interdisciplinary Research on AIDS, Yale School of Public Health, New Haven, CT
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Kierstead EC, Harvey E, Sanchez D, Horn K, Abroms LC, Spielberg F, Stanton CA, Debnam C, Cohn AM, Gray T, Magnus M, Patel M, Niaura R, Elf JL. A pilot randomized controlled trial of a tailored smoking cessation program for people living with HIV in the Washington, D.C. metropolitan area. BMC Res Notes 2021; 14:2. [PMID: 33407848 PMCID: PMC7789216 DOI: 10.1186/s13104-020-05417-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 12/09/2020] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE Morbidity and mortality from smoking-related diseases among people living with HIV (PLWH) in the U.S. surpasses that due to HIV itself. Conventional smoking cessation treatments have not demonstrated strong efficacy among PLWH. We conducted a pilot randomized controlled trial (RCT) to evaluate a tailored smoking cessation intervention based on the minority stress model. We compared standard of care counseling (SOC) to a tailored intervention (TI) including one face-to-face counseling session incorporating cognitive behavioral therapy to build resilience, and 30 days of 2-way text messaging. RESULTS The primary outcome was smoking cessation. Secondary outcomes included cigarettes per day (CPD), exhaled carbon monoxide (CO), and cessation self-efficacy. A total of 25 participants were enrolled (TI:11, SOC:14), and 2 were lost to follow-up. There were no significant differences in quit rates between study groups. However, there was a significantly greater decrease in CPD in the TI versus SOC (13.5 vs. 0.0, p-value:0.036). Additionally, self-efficacy increased in both groups (TI p-value:0.012, SOC p-value:0.049) and CO decreased in both groups (TI p-value: < 0.001, SOC p-value:0.049). This intervention shows promise to support smoking cessation among PLWH. A larger study is needed to fully evaluate the efficacy of this approach. CLINICAL TRIAL Trial Registration: Retrospectively registered (10/20/2020) NCT04594109.
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Affiliation(s)
- Elexis C. Kierstead
- Schroeder Institute, Truth Initiative, 900 G St. NW, Washington, DC USA
- Department of Epidemiology, Milken Institute School of Public Health, The George Washington University, Washington, DC USA
| | - Emily Harvey
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD USA
| | - Denisse Sanchez
- Schroeder Institute, Truth Initiative, 900 G St. NW, Washington, DC USA
| | - Kimberly Horn
- Carilion Fralin Biomedical Research Institute at VTC, Virginia Polytechnic Institute and State University, Blacksburg, VA USA
- Department of Population Health Sciences, Virginia-Maryland College of Veterinary Medicine, Virginia Polytechnic Institute and State University, Blacksburg, VA USA
| | - Lorien C. Abroms
- Department of Prevention and Community Health, Milken Institute School of Public Health, The George Washington University, Washington, USA
| | - Freya Spielberg
- Department of Population Health, Dell Medical School, University of Texas, Austin, TX USA
| | | | | | - Amy M. Cohn
- Department of Pediatrics, University of Oklahoma College of Medicine, Oklahoma City, OK USA
| | - Tiffany Gray
- Department of Community Health Administration, Department of Health, Washington, DC USA
| | - Manya Magnus
- Department of Epidemiology, Milken Institute School of Public Health, The George Washington University, Washington, DC USA
| | - Minal Patel
- Schroeder Institute, Truth Initiative, 900 G St. NW, Washington, DC USA
| | - Raymond Niaura
- Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York City, NY USA
| | - Jessica L. Elf
- Department of Environmental and Radiological Health Sciences, College of Veterinary Medicine & Biomedical Sciences, Fort Collins, CO USA
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Byanova KL, Kunisaki KM, Vasquez J, Huang L. Chronic obstructive pulmonary disease in HIV. Expert Rev Respir Med 2021; 15:71-87. [PMID: 33167728 PMCID: PMC7856058 DOI: 10.1080/17476348.2021.1848556] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 11/05/2020] [Indexed: 02/06/2023]
Abstract
Introduction: Chronic obstructive pulmonary disease (COPD) is more prevalent in people with HIV (PWH) than in the general population and leads to an increased burden of morbidity and mortality in this population. The mechanisms behind COPD development and progression in PWH are not fully elucidated, and there are no PWH-specific guidelines for COPD management. Areas covered: The goal of this broad narrative review is to review the epidemiology of COPD in PWH globally, highlight proposed pathways contributing to increased COPD prevalence and progression in PWH, discuss structural and functional changes in the lungs in this population, assesses the excess mortality and comorbidities in PWH with COPD, and address management practices for this unique population. Expert opinion: Understanding how a chronic viral infection leads to COPD, independent of cigarette smoking, is of critical scientific importance. Further research should focus on the pathophysiology of the interaction between HIV and COPD, and determine the role of disease-modifying risk factors such as opportunistic pneumonia and air pollution, as well as generate data from randomized clinical trials on the safety and efficacy of specific therapies for this vulnerable patient population.
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Affiliation(s)
- Katerina L Byanova
- Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Ken M. Kunisaki
- Section of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Minneapolis Veterans Affairs Health Care System, Minneapolis, MN, USA
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Joshua Vasquez
- Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
- Division of Experimental Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Laurence Huang
- Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
- HIV, Infectious Diseases, and Global Medicine Division, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
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Bien-Gund CH, Choi GH, Mashas A, Shaw PA, Miller M, Gross R, Brady KA. Persistent Disparities in Smoking Rates Among PLWH Compared to the General Population in Philadelphia, 2009-2014. AIDS Behav 2021; 25:148-153. [PMID: 32591983 DOI: 10.1007/s10461-020-02952-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Despite reductions in smoking rates in the general population, little is known about recent smoking trends among people living with HIV (PLWH). We compared the risk for smoking and temporal trends in smoking among PLWH and the general population in the Philadelphia metropolitan area between 2009 and 2014. We used weighted logistic regression to assess the relation between HIV and smoking, and examined temporal smoking trends. The adjusted odds ratio (OR) for smoking comparing PLWH to the general population was 1.80 (95% CI 1.55-2.09) after adjusting for socio-economic, demographic, and mental health diagnosis variables. Smoking prevalence decreased in both the PLWH and general populations during the study period, and we did not observe a significant difference in rates of decline between groups (P = 0.54). Despite overall progress in smoking cessation, a disparity persisted in smoking rates between PLWH and the general population, with and without adjustment for socio-economic, demographic, and mental health variables. Further research is needed to understand the mechanisms linking HIV and tobacco use in order to inform public health efforts to reduce smoking among PLWH.
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Affiliation(s)
- Cedric H Bien-Gund
- Division of Infectious Diseases, Department of Medicine, University of Pennsylvania Perelman School of Medicine, 3400 Spruce Street, Philadelphia, PA, 19104, USA.
| | - Grace H Choi
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Philadelphia Department of Public Health, AIDS Activities Coordinating Office, Philadelphia, PA, USA
| | - Antonios Mashas
- Philadelphia Department of Public Health, AIDS Activities Coordinating Office, Philadelphia, PA, USA
| | - Pamela A Shaw
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Melissa Miller
- Philadelphia Department of Public Health, AIDS Activities Coordinating Office, Philadelphia, PA, USA
| | - Robert Gross
- Division of Infectious Diseases, Department of Medicine, University of Pennsylvania Perelman School of Medicine, 3400 Spruce Street, Philadelphia, PA, 19104, USA
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA
| | - Kathleen A Brady
- Philadelphia Department of Public Health, AIDS Activities Coordinating Office, Philadelphia, PA, USA
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Bauer AM, Hosie Quinn M, Lubitz SF, Flitter A, Ashare RL, Leone FT, Gross R, Hitsman B, Schnoll R. Medication adherence and rate of nicotine metabolism are associated with response to treatment with varenicline among smokers with HIV. Addict Behav 2021; 112:106638. [PMID: 32911350 DOI: 10.1016/j.addbeh.2020.106638] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 08/27/2020] [Accepted: 08/28/2020] [Indexed: 12/21/2022]
Abstract
INTRODUCTION PLWHA who smoke have shown lower cessation rates within placebo-controlled randomized trials of varenicline. Adherence and rate of nicotine metabolism may be associated with quit rates in such clinical trials. METHODS This secondary analysis of a randomized placebo-controlled trial of varenicline for smoking among PLWHA (N = 179) examined the relationship between varenicline adherence (pill count, ≥80% of pills), nicotine metabolism (based on the nicotine metabolite ratio; NMR) and end-of-treatment smoking cessation (self-reported 7-day point prevalence abstinence, confirmed with carbon monoxide of ≤ 8 ppm, at the end of treatment; EOT). RESULTS Combining varenicline and placebo arms, greater adherence (OR = 1.011, 95% CI:1.00-1.02, p = 0.051) and faster nicotine metabolism (OR = 3.08, 95% CI:1.01-9.37, p = 0.047) were related to higher quit rates. In separate models, adherence (OR = 1.009, 95% CI:1.004-1.01, p < 0.001) and nicotine metabolism rate (OR = 2.04, 95% CI:1.19-3.49, p = 0.009) interacted with treatment arm to effect quit rates. The quit rate for varenicline vs. placebo was higher for both non-adherent (19% vs. 5%; χ2[1] = 2.80, p = 0.09) and adherent (35% vs. 15%; χ2[1] = 6.51, p = 0.01) participants, but the difference between treatment arms was statistically significant only for adherent participants. Likewise, among slow metabolizers (NMR < 0.31), the varenicline quit rate was not significantly higher vs. placebo (14% vs. 5%; χ2[1] = 1.17, p = 0.28) but, among fast metabolizers (NMR ≥ 0.31), the quit rate for varenicline was significantly higher vs. placebo (33% vs. 14%; χ2[1] = 4.43, p = 0.04). CONCLUSIONS Increasing varenicline adherence and ensuring that fast nicotine metabolizers receive varenicline may increase quit rates for PLWHA.
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Affiliation(s)
| | | | - Su Fen Lubitz
- Department of Psychiatry, University of Pennsylvania, United States
| | - Alex Flitter
- Department of Psychiatry, University of Pennsylvania, United States
| | - Rebecca L Ashare
- Department of Psychiatry, University of Pennsylvania, United States
| | - Frank T Leone
- Department of Medicine/Division of Pulmonary, Allergy, & Critical Care, University of Pennsylvania, United States
| | - Robert Gross
- Department of Medicine/Division of Infectious Diseases, University of Pennsylvania, United States; Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, United States
| | - Brian Hitsman
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, United States
| | - Robert Schnoll
- Department of Psychiatry and Abramson Cancer Center, University of Pennsylvania, United States.
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Thompson MA, Horberg MA, Agwu AL, Colasanti JA, Jain MK, Short WR, Singh T, Aberg JA. Primary Care Guidance for Persons With Human Immunodeficiency Virus: 2020 Update by the HIV Medicine Association of the Infectious Diseases Society of America. Clin Infect Dis 2020; 73:e3572-e3605. [PMID: 33225349 DOI: 10.1093/cid/ciaa1391] [Citation(s) in RCA: 103] [Impact Index Per Article: 25.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 09/11/2020] [Indexed: 12/15/2022] Open
Abstract
Advances in antiretroviral therapy (ART) have made it possible for persons with human immunodeficiency virus (HIV) to live a near expected life span, without progressing to AIDS or transmitting HIV to sexual partners or infants. There is, therefore, increasing emphasis on maintaining health throughout the life span. To receive optimal medical care and achieve desired outcomes, persons with HIV must be consistently engaged in care and able to access uninterrupted treatment, including ART. Comprehensive evidence-based HIV primary care guidance is, therefore, more important than ever. Creating a patient-centered, stigma-free care environment is essential for care engagement. Barriers to care must be decreased at the societal, health system, clinic, and individual levels. As the population ages and noncommunicable diseases arise, providing comprehensive healthcare for persons with HIV becomes increasingly complex, including management of multiple comorbidities and the associated challenges of polypharmacy, while not neglecting HIV-related health concerns. Clinicians must address issues specific to persons of childbearing potential, including care during preconception and pregnancy, and to children, adolescents, and transgender and gender-diverse individuals. This guidance from an expert panel of the HIV Medicine Association of the Infectious Diseases Society of America updates previous 2013 primary care guidelines.
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Affiliation(s)
| | - Michael A Horberg
- Mid-Atlantic Permanente Research Institute, Kaiser Permanente Mid-Atlantic Permanente Medical Group, Rockville, Maryland, USA
| | - Allison L Agwu
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | | | - Mamta K Jain
- Division of Infectious Diseases, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - William R Short
- Division of Infectious Diseases, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Tulika Singh
- Internal Medicine, HIV and Infectious Disease, Desert AIDS Project, Palm Springs, California, USA
| | - Judith A Aberg
- Division of Infectious Diseases, Mount Sinai Health System, New York, New York, USA
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Chang L, Liang H, Kandel SR, He JJ. Independent and Combined Effects of Nicotine or Chronic Tobacco Smoking and HIV on the Brain: A Review of Preclinical and Clinical Studies. J Neuroimmune Pharmacol 2020; 15:658-693. [PMID: 33108618 DOI: 10.1007/s11481-020-09963-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 09/25/2020] [Indexed: 02/07/2023]
Abstract
Tobacco smoking is highly prevalent among HIV-infected individuals. Chronic smokers with HIV showed greater cognitive deficits and impulsivity, and had more psychopathological symptoms and greater neuroinflammation than HIV non-smokers or smokers without HIV infection. However, preclinical studies that evaluated the combined effects of HIV-infection and tobacco smoking are scare. The preclinical models typically used cell cultures or animal models that involved specific HIV viral proteins or the administration of nicotine to rodents. These preclinical models consistently demonstrated that nicotine had neuroprotective and anti-inflammatory effects, leading to cognitive enhancement. Although the major addictive ingredient in tobacco smoking is nicotine, chronic smoking does not lead to improved cognitive function in humans. Therefore, preclinical studies designed to unravel the interactive effects of chronic tobacco smoking and HIV infection are needed. In this review, we summarized the preclinical studies that demonstrated the neuroprotective effects of nicotine, the neurotoxic effects of the HIV viral proteins, and the scant literature on nicotine or tobacco smoke in HIV transgenic rat models. We also reviewed the clinical studies that evaluated the neurotoxic effects of tobacco smoking, HIV infection and their combined effects on the brain, including studies that evaluated the cognitive and behavioral assessments, as well as neuroimaging measures. Lastly, we compared the different approaches between preclinical and clinical studies, identified some gaps and proposed some future directions. Graphical abstract Independent and combined effects of HIV and tobacco/nicotine. Left top and bottom panels: Both clinical studies of HIV infected persons and preclinical studies using viral proteins in vitro or in vivo in animal models showed that HIV infection could lead to neurotoxicity and neuroinflammation. Right top and bottom panels: While clinical studies of tobacco smoking consistently showed deleterious effects of smoking, clinical and preclinical studies that used nicotine show mild cognitive enhancement, neuroprotective and possibly anti-inflammatory effects. In the developing brain, however, nicotine is neurotoxic. Middle overlapping panels: Clinical studies of persons with HIV who were smokers typically showed additive deleterious effects of HIV and tobacco smoking. However, in the preclinical studies, when nicotine was administered to the HIV-1 Tg rats, the neurotoxic effects of HIV were attenuated, but tobacco smoke worsened the inflammatory cascade.
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Affiliation(s)
- Linda Chang
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, 670 W. Baltimore Street, HSF III, Baltimore, MD, 21201, USA.
- Department of Neurology, University of Maryland School of Medicine, Baltimore, MD, USA.
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
- Department of Medicine, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, HI, USA.
| | - Huajun Liang
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, 670 W. Baltimore Street, HSF III, Baltimore, MD, 21201, USA
| | - Suresh R Kandel
- Department of Microbiology and Immunology, Chicago Medical School, Center for Cancer Cell Biology, Immunology and Infection, Rosalind Franklin University, 3333 Green Bay Road, Basic Science Building 2.300, North Chicago, IL, 60064, USA
| | - Johnny J He
- Department of Microbiology and Immunology, Chicago Medical School, Center for Cancer Cell Biology, Immunology and Infection, Rosalind Franklin University, 3333 Green Bay Road, Basic Science Building 2.300, North Chicago, IL, 60064, USA.
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Abbamonte JM, Sawhney M, Alcaide ML, Weiss SM, Kumar M, Asfar T, Jones DL. The association of HIV and cocaine use to cigarette smoking in the context of depression and perceived stress. AIDS Care 2020; 32:1229-1237. [PMID: 32539456 PMCID: PMC7529880 DOI: 10.1080/09540121.2020.1778627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 06/02/2020] [Indexed: 10/24/2022]
Abstract
Mental well-being can contribute to cigarette smoking and negatively impact disease progression among people living with HIV (PLWH). This study examined potential associations between cocaine use (COC), depression, and HIV status in predicting cigarette smoking; hypothesizing that depression would be highest in cocaine users and predict cigarette smoking. An exploratory analysis including stress was also examined as a potential predictor of cigarette use. More than half of the sample (65%) endorsed smoking at some point in the past, and 52% endorsed being current smokers at the time of the study. Smokers were most likely to be cocaine users (87.1%), cocaine using PLWH (74.3%), or PLWH (36.6%). Neither HIV status (χ2(1) = 1.5, p = .221), perceived stress (χ2(1) = 0.75 p = .386), nor depressive symptomatology (χ2(1) = 1.2, p = .274) were related to smoking. Non-cocaine users were approximately 95.4% less likely to smoke than cocaine users, controlling for all other variables. Overall, cocaine use was the greatest predictor of cigarette smoking and quantity of cigarettes smoked. Perceived stress and depression were not associated with cigarette smoking in the sample. Future interventions targeting cigarette use should include a cocaine-related component to encourage smoking cessation among this high-risk group.
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Affiliation(s)
- J M Abbamonte
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - M Sawhney
- Liffrig Family School of Education & Behavioral Sciences, University of Mary, Bismarck, ND, USA
| | - M L Alcaide
- Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - S M Weiss
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - M Kumar
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - T Asfar
- Department of Public Health, University of Miami Miller School of Medicine, Miami, FL, USA
| | - D L Jones
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
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Ashare RL, Wileyto EP, Logue-Chamberlain E, Gross R, Tyndale RF, Lerman C, Hawk LW, Cinciripini P, George TP, Lubitz SF, Schnoll R. Patterns of lapses and recoveries during a quit attempt using varenicline and behavioral counseling among smokers with and without HIV. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2020; 35:788-796. [PMID: 32686950 DOI: 10.1037/adb0000619] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Addressing tobacco use among HIV+ smokers is a priority. Lack of knowledge about how HIV+ smokers respond to tobacco use treatments limits our ability to effectively treat this population of smokers. Using data from 2 clinical trials that provided 12 weeks of varenicline and behavioral counseling, 1 with smokers with HIV (n = 89) and 1 with smokers without HIV (n = 179), we used mixed logistic regression modeling to compare point-prevalence abstinence rates and adherence to the initial target quit date (TQD) and Cox regression for repeated outcomes to evaluate lapse and recovery dynamics between the groups. Sixty percent of HIV- smokers refrained from smoking at the TQD while only 33% of HIV+ smokers did (odds ratio [OR] = 0.32, 95% CI [0.18, 0.56], p < .001). The point-prevalence abstinence rates at Week 12 were 31% (HIV-) and 28% (HIV+; OR = 0.7, 95% CI [0.42, 1.16], p = .16) and the point prevalence abstinence rates at Week 24 were 22% (HIV-) and 15% (HIV+; OR = 0.87, 95% CI [0.49, 1.57], p = .65). Although there was no interaction between HIV status and lapse risk, χ2(3) < 1, there was a significant interaction for the recovery model, (χ2(3) = 20.4, p < 0.001): as the number of events increased, the time to the next recovery became longer among smokers with HIV, compared to smokers without HIV. Although HIV+ smokers were treated effectively with varenicline, compared to HIV- smokers, they showed significantly lower initial cessation at the TQD and took increasingly longer to recover following lapses. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
| | | | | | - Robert Gross
- Center for Clinical Epidemiology and Biostatistics and Division of Infectious Diseases
| | - Rachel F Tyndale
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health and Department of Pharmacology and Toxicology, and Division of Brain and Therapeutics
| | | | | | | | - Tony P George
- Addictions Division, Centre for Addiction and Mental Health and Division of Brain and Therapeutics
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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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Murphy JD, Liu B, Parascandola M. Smoking and HIV in Sub-Saharan Africa: A 25-Country Analysis of the Demographic Health Surveys. Nicotine Tob Res 2020; 21:1093-1102. [PMID: 30165688 DOI: 10.1093/ntr/nty176] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Accepted: 08/25/2018] [Indexed: 12/24/2022]
Abstract
BACKGROUND Having HIV/AIDS has been associated with a higher prevalence of smoking. Moreover, evidence suggests that people with HIV/AIDS who smoke have poorer treatment and survival outcomes. The HIV-smoking relationship is understudied in sub-Saharan Africa, where tobacco use patterns and HIV prevalence differ greatly from other world regions. METHODS Cross-sectional data from the Demographic Health Surveys and AIDS Indicator Surveys, representing 25 sub-Saharan African countries, were pooled for analysis (n = 286850). The association between cigarette smoking and HIV status was analyzed through hierarchical logistic regression models. This study also examined the relationship between smokeless tobacco (SLT) use and HIV status. RESULTS Smoking prevalence was significantly higher among men who had HIV/AIDS than among men who did not (25.90% vs 16.09%; p < .0001), as was smoking prevalence among women who had HIV/AIDS compared with women who did not (1.15% vs 0.73%; p < .001). Multivariate logistic regression revealed that the odds of smoking among people who had HIV/AIDS was 1.12 times greater than among people who did not when adjusting for socioeconomic, demographic, and sexual risk factors (adjusted OR = 1.12, 95% CI = 1.04% to 1.21%; p < .001). Similarly, multivariate logistic regression revealed that HIV-positive individuals were 34% more likely to use SLT than HIV-negative individuals (adjusted OR = 1.34, 95% CI = 1.17% to 1.53%). CONCLUSION Having HIV was associated with a greater likelihood of smoking cigarettes as well as with using SLT in sub-Saharan Africa. These tobacco use modalities were also associated with male sex and lower socioeconomic status. IMPLICATIONS This study shows that in sub-Saharan Africa, as in more studied world regions, having HIV/AIDS is associated with a higher likelihood of smoking cigarettes when adjusting for demographic, socioeconomic, and sexual risk factors. This study also supports the literature stating that cigarette smoking is inversely associated with socioeconomic status, as evidenced by higher smoking prevalence among poorer individuals, less educated individuals, and manual and agricultural laborers.
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Affiliation(s)
- John D Murphy
- Epidemiology and Genomics Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD
| | - Benmei Liu
- Surveillance Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD
| | - Mark Parascandola
- Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD
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Thompson M, Schnoll R, Serrano K, Leone F, Gross R, Collman RG, Ashare RL. The effect of varenicline on mood and cognition in smokers with HIV. Psychopharmacology (Berl) 2020; 237:1223-1231. [PMID: 31938877 PMCID: PMC7125016 DOI: 10.1007/s00213-020-05451-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 01/02/2020] [Indexed: 01/24/2023]
Abstract
RATIONALE Barriers to smoking cessation, including negative affect and cognitive dysfunction, may contribute to high smoking rates among people living with HIV/AIDS (PLWH). Varenicline may help PLWH quit smoking by improving mood and cognition, yet this has not been explored. OBJECTIVES The goal of this study was to evaluate the effect of varenicline on mood and cognition among PLWH enrolled in a smoking cessation clinical trial. METHODS In this secondary analysis of a varenicline trial (NCT01710137), we assessed mood (depression, anxiety) and cognition (attention, working memory) at weeks 0 (baseline), 1, 3, and 12 (end-of-treatment, EOT). Primary outcomes were changes in mood and cognition from baseline to EOT. Secondarily, mood and cognition were evaluated as predictors of biochemically confirmed 7-day point-prevalence abstinence at EOT. RESULTS Overall, 173 subjects (87 varenicline, 86 placebo) were included. At EOT, varenicline reduced anxiety (P < 0.001), vs. placebo (P = 0.31; interaction P = 0.05). Across both treatment arms, reductions in anxiety from baseline to EOT were associated with a higher likelihood of abstinence (OR = 1.3, 95% CI 1.1 to 1.6, P = 0.01). There were no significant treatment by time interactions for cognition or depression. CONCLUSIONS These data suggest that varenicline operates, at least in part, by reducing anxiety. Anxiety should be an intervention target for smokers with HIV interested in quitting.
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Affiliation(s)
- Morgan Thompson
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, Suite 4100, Philadelphia, PA, USA
| | - Robert Schnoll
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, Suite 4100, Philadelphia, PA, USA
| | - Katrina Serrano
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, Suite 4100, Philadelphia, PA, USA
| | - Frank Leone
- Pulmonary, Allergy, & Critical Care Division, Presbyterian Medical Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Robert Gross
- Division of Infectious Diseases, University of Pennsylvania, Philadelphia, PA, USA
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA, USA
| | - Ronald G Collman
- Pulmonary, Allergy and Critical Care Division, University of Pennsylvania, Philadelphia, PA, USA
| | - Rebecca L Ashare
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, Suite 4100, Philadelphia, PA, USA.
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Antoniou T, Yao Z, Raboud J, Gershon AS. Incidence of chronic obstructive pulmonary disease in people with HIV in Ontario, 1996-2015: a retrospective population-based cohort study. CMAJ Open 2020; 8:E83-E89. [PMID: 32071142 PMCID: PMC7028164 DOI: 10.9778/cmajo.20190028] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Because of high smoking rates and HIV-related factors, people with HIV may be at high risk for chronic obstructive pulmonary disease (COPD); however, population-based estimates of the incidence of COPD among people with HIV are lacking, particularly for women. We compared the incidence of COPD among Ontario adults aged 35 years or more with and without HIV between Jan. 1, 1996, and Dec. 31, 2015. METHODS We conducted a population-based study using Ontario's health administrative databases. We compared the incidence of COPD between people with and without HIV using standardized incidence ratios and generalized estimating equations with a log link function. RESULTS We identified 1849 people with HIV and 1 168 727 HIV-negative people who were newly diagnosed with COPD between 1996 and 2015. People with HIV were younger than HIV-negative people (mean age 49.7 [standard deviation 10.4] yr v. 62.2 [standard deviation 14.8] yr; standardized difference 0.98). Rates of COPD were higher among people with HIV than among HIV-negative people (10.4 v. 9.0 cases per 1000 person-years; standardized incidence ratio 1.16, 95% confidence interval [CI] 1.10 to 1.21; adjusted rate ratio 1.34, 95% CI 1.27 to 1.41). In sex-stratified analyses, rates of COPD were higher among men with HIV (adjusted rate ratio 1.32, 95% CI 1.24 to 1.40) and women with HIV (adjusted rate ratio 1.54, 95% CI 1.37 to 1.72) than among men and women without HIV. In a sensitivity analysis, smoking explained observed differences in COPD incidence. INTERPRETATION People with HIV had higher rates of incident COPD than HIV-negative people. This may reflect the disproportionately higher prevalence of smoking among the former.
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Affiliation(s)
- Tony Antoniou
- ICES (Antoniou, Yao, Gershon); Department of Family and Community Medicine (Antoniou), Li Ka Shing Knowledge Institute, St. Michael's Hospital and University of Toronto; Toronto General Hospital Research Institute (Raboud); Dalla Lana School of Public Health (Raboud), University of Toronto; Department of Medicine (Gershon), Sunnybrook Health Sciences Centre, Toronto, Ont.
| | - Zhan Yao
- ICES (Antoniou, Yao, Gershon); Department of Family and Community Medicine (Antoniou), Li Ka Shing Knowledge Institute, St. Michael's Hospital and University of Toronto; Toronto General Hospital Research Institute (Raboud); Dalla Lana School of Public Health (Raboud), University of Toronto; Department of Medicine (Gershon), Sunnybrook Health Sciences Centre, Toronto, Ont
| | - Janet Raboud
- ICES (Antoniou, Yao, Gershon); Department of Family and Community Medicine (Antoniou), Li Ka Shing Knowledge Institute, St. Michael's Hospital and University of Toronto; Toronto General Hospital Research Institute (Raboud); Dalla Lana School of Public Health (Raboud), University of Toronto; Department of Medicine (Gershon), Sunnybrook Health Sciences Centre, Toronto, Ont
| | - Andrea S Gershon
- ICES (Antoniou, Yao, Gershon); Department of Family and Community Medicine (Antoniou), Li Ka Shing Knowledge Institute, St. Michael's Hospital and University of Toronto; Toronto General Hospital Research Institute (Raboud); Dalla Lana School of Public Health (Raboud), University of Toronto; Department of Medicine (Gershon), Sunnybrook Health Sciences Centre, Toronto, Ont
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Cioe PA, Mercurio AN, Lechner W, Costantino CC, Tidey JW, Eissenberg T, Kahler CW. A pilot study to examine the acceptability and health effects of electronic cigarettes in HIV-positive smokers. Drug Alcohol Depend 2020; 206:107678. [PMID: 31711874 PMCID: PMC9295550 DOI: 10.1016/j.drugalcdep.2019.107678] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 09/29/2019] [Accepted: 10/07/2019] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Some HIV-positive smokers report ambivalence about quitting. Switching to electronic cigarettes (ECs) may be a viable option to reduce the negative health effects for smokers who are unable or unwilling to quit smoking combustible cigarettes (CCs). This study examined the acceptability and health-related effects of ECs in HIV-positive smokers who were not seeking smoking cessation treatment. METHODS HIV-positive smokers (N = 19) were enrolled and followed for 12 weeks. Cartridge-based ECs were provided at baseline, and E-liquid was provided weekly for 8 weeks. At baseline, weeks 1-8, and week 12, EC and CC use, cardiopulmonary function, respiratory symptoms, and carbon monoxide (CO) levels were measured. RESULTS At week 8, cigarettes per day (CPD) were reduced by more than 80%, with reduction maintained at week 12 (p's < .001). Cigarette dependence scores were 40% lower at week 8 than at baseline (p < .001). Seven (36.8%) participants reported transitioning completely from CCs to ECs. Mean CO decreased significantly from BL to week 8 (p < .05) and remained significantly lower at week 12 (p < .001). Intention to quit increased significantly over time. CONCLUSIONS Switching from CCs to ECs in HIV-positive smokers who are not ready to quit smoking in the next 30 days appears to be feasible. Beneficial effects were seen, such as reduced CPD, reduced CO and CC dependence, and increased motivation to quit. ECs may be promising as a harm reduction approach among HIV-positive smokers who are unable or unwilling to quit smoking.
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Affiliation(s)
- Patricia A Cioe
- Center for Alcohol and Addiction Studies, Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA.
| | - Alana N Mercurio
- Center for Alcohol and Addiction Studies, Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
| | - William Lechner
- Department of Psychological Sciences, Kent State University, Kent, OH, USA
| | - Catherine C Costantino
- Center for Alcohol and Addiction Studies, Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
| | - Jennifer W Tidey
- Center for Alcohol and Addiction Studies, Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
| | - Thomas Eissenberg
- Department of Psychology and Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, VA, USA
| | - Christopher W Kahler
- Center for Alcohol and Addiction Studies, Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
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50
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Ghura S, Gross R, Jordan-Sciutto K, Dubroff J, Schnoll R, Collman RG, Ashare RL. Bidirectional Associations among Nicotine and Tobacco Smoke, NeuroHIV, and Antiretroviral Therapy. J Neuroimmune Pharmacol 2019; 15:694-714. [PMID: 31834620 DOI: 10.1007/s11481-019-09897-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 12/01/2019] [Indexed: 12/12/2022]
Abstract
People living with HIV (PLWH) in the antiretroviral therapy (ART) era may lose more life-years to tobacco use than to HIV. Yet, smoking rates are more than twice as high among PLWH than the general population, contributing not just to mortality but to other adverse health outcomes, including neurocognitive deficits (neuroHIV). There is growing evidence that synergy with chronic inflammation and immune dysregulation that persists despite ART may be one mechanism by which tobacco smoking contributes to neuroHIV. This review will summarize the differential effects of nicotine vs tobacco smoking on inflammation in addition to the effects of tobacco smoke components on HIV disease progression. We will also discuss biomarkers of inflammation via neuroimaging as well as biomarkers of nicotine dependence (e.g., nicotine metabolite ratio). Tobacco smoking and nicotine may impact ART drug metabolism and conversely, certain ARTs may impact nicotine metabolism. Thus, we will review these bidirectional relationships and how they may contribute to neuroHIV and other adverse outcomes. We will also discuss the effects of tobacco use on the interaction between peripheral organs (lungs, heart, kidney) and subsequent CNS function in the context of HIV. Lastly, given the dramatic rise in the use of electronic nicotine delivery systems, we will discuss the implications of vaping on these processes. Despite the growing recognition of the importance of addressing tobacco use among PLWH, more research is necessary at both the preclinical and clinical level to disentangle the potentially synergistic effects of tobacco use, nicotine, HIV, cognition and immune dysregulation, as well as identify optimal approaches to reduce tobacco use. Graphical Abstract Proposed model of the relationships among HIV, ART, smoking, inflammation, and neurocognition. Solid lines represent relationships supported by evidence. Dashed lines represent relationships for which there is not enough evidence to make a conclusion. (a) HIV infection produces elevated levels of inflammation even among virally suppressed individuals. (b) HIV is associated with deficits in cognition function. (c) Smoking rates are higher among PLWH, compared to the general population. (d) The nicotine metabolite ratio (NMR) is associated with smoking behavior. (e) HIV and tobacco use are both associated with higher rates of psychiatric comorbidities, such as depression, and elevated levels of chronic stress. These factors may represent other mechanisms linking HIV and tobacco use. (f) The relationship between nicotine, tobacco smoking, and inflammation is complex, but it is well-established that smoking induces inflammation; the evidence for nicotine as anti-inflammatory is supported in some studies, but not others. (g) The relationship between tobacco use and neurocognition may differ for the effects of nicotine (acute nicotine use may have beneficial effects) vs. tobacco smoking (chronic use may impair cognition). (h) Elevated levels of inflammation may be associated with deficits in cognition. (i) PLWH may metabolize nicotine faster than those without HIV; the mechanism is not yet known and the finding needs validation in larger samples. We also hypothesize that if HIV-infection increases nicotine metabolism, then we should observe an attenuation effect once ART is initiated. (j) It is possible that the increase in NMR is due to ART effects on CYP2A6. (k) We hypothesize that faster nicotine metabolism may result in higher levels of inflammation since nicotine has anti-inflammatory properties.
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Affiliation(s)
- Shivesh Ghura
- Department of Pathology, School of Dental Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Robert Gross
- Division of Infectious Diseases, University of Pennsylvania, Philadelphia, PA, USA.,Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA, USA
| | - Kelly Jordan-Sciutto
- Department of Pathology, School of Dental Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Jacob Dubroff
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Robert Schnoll
- Department of Psychiatry, University of Pennsylvania, 3535 Market Street, Suite, Philadelphia, PA, 4100, USA
| | - Ronald G Collman
- Pulmonary, Allergy and Critical Care Division, University of Pennsylvania, Philadelphia, PA, USA
| | - Rebecca L Ashare
- Department of Psychiatry, University of Pennsylvania, 3535 Market Street, Suite, Philadelphia, PA, 4100, USA.
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