HIV Infection and Tobacco Use
As the largest single provider of HIV care in the country, VA has approximately 26,000 Veterans in care who are living with HIV/AIDS. Veterans with HIV have higher smoking rates than the general U.S. population.
Health effects of HIV and tobacco use
While approximately 18% of the U.S. general population smokes, individuals living with HIV are 2-3 times more likely to smoke. Individuals with HIV who smoke are at risk for the same negative health effects as smokers without HIV. In addition to those effects, smokers with HIV:
- Face an increased all-cause mortality
- Are more likely to experience AIDS-related illnesses such as Pneumocystis jirovecii pneumonia, tuberculosis, and oral candidiasis
- Are more likely to experience non-AIDS related diseases such as cardiovascular and pulmonary conditions, and non-AIDS cancers
- May experience a decreased response to antiretroviral therapy and more rapid progression to AIDS
Positive outcomes of tobacco cessation
When providers assist individuals with HIV in a successful quit attempt, the positive outcomes include:
- Addressing the most important modifiable cardiovascular risk factor among HIV-infected individuals
- Decreasing the risk of a cardiovascular event as the length of abstinence increases
- Decreasing the HIV-related symptom burden as the length of abstinence increases
Interventions for those living with HIV
To date, little research has focused on what tobacco cessation interventions work best for individuals living with HIV/AIDS. A published systematic review of peer-reviewed literature highlighted considerations that should be taken into account when developing a smoking cessation program for individuals living with HIV:
- Use of multiple strategies to address cessation, which include counseling interventions (delivered in multiple sessions) and smoking cessation pharmacotherapy
- An intervention that uses the 5 A’s (Ask, Advise, Assess, Assist, and Arrange) to address tobacco cessation benefits that are specific to individuals living with HIV/AIDS
- Interventions that assess the presence of comorbidities such as psychiatric disorders and addictions
- Interventions that use "access-promoting elements" such as cessation counseling delivered through cell phones
In terms of smoking cessation medication interactions with antiretroviral therapy (ART), interactions have been noted with bupropion and the use of efavirenz, ritonavir, and tipranavir. These medications may decrease bupropion levels 40-50%, so patients need to be monitored for depression and the medication titrated to clinical effect.
Nicotine replacement therapy (NRT) patch, gum, and lozenge have no interactions with ART.
Varenicline has had no ART interactions identified to date.
Tools and publications
- HIV Provider Smoking Cessation Handbook: A Resource for Providers (983 KB, PDF)
- My Smoking Cessation Workbook: A Resource for Patients (HIV focused) (1.55 MB, PDF)
- AIDS.gov Smoking & Tobacco Use
- Patient tools
- 1-855-QUIT-VET, telephone counseling for Veterans with or without psychiatric disorders
- SmokefreeVET text messaging program, augments and extends treatment and support for Veterans attempting to quit
- Centers for Disease Control and Prevention. (2014). Current cigarette smoking among adults — United States, 2005-2012. Morbidity and Mortality Weekly Report, 63(02), 29-34.
- Kwong, J., & Bouchard-Miller, K., (2010). Smoking cessation for persons living with HIV: A review of currently available interventions. Journal of the Association of Nurses in AIDS Care, 21(1), 3-10.
- Mamary, E. M., Bahrs, D., & Martinez, S. (2002). Cigarette smoking and the desire to quit among individuals living with HIV. AIDS Patient Care and STDs, 16(1), 39-42.
- Moscou-Jackson, G., Commodore, Mensah, Y., Farley, J., & DiGiacomo, M. (2014). Smoking-cessation interventions in people living with HIV infection: A systematic review. Journal of the Association of Nurses in AIDS Care, 25(1), 32-45.
- U.S. Department of Veterans Affairs. (2012). The state of care for veterans with HIV/AIDS: 2011 summary report.