Interventions to address chronic disease and HIV: strategies to promote smoking cessation among HIV-infected individuals

Abstract

Tobacco use, especially cigarette smoking, is higher than average in persons living with HIV/AIDS (PLWHA). The Public Health Service Clinical Practice Guideline for Treating Tobacco Use and Dependence states that, during every medical encounter, all smokers should be offered smoking cessation counseling, along with approved medications. The Guideline also recognizes PLWHA as a priority population, given the scarcity of research on effective cessation treatments in this group. The scant evidence suggests that conventional treatments, though worthwhile, are not as successful as might be hoped for. The reasons for this are not entirely clear, but may have to do with the complex array of medical and psychosocial factors that complicate their lives. Clinicians should consider re-treatment strategies for those patients who encounter difficulty when quitting smoking with conventional approaches, switching or augmenting treatments as needed to minimize adverse experiences, and to maximize tolerability, adherence, and cessation outcomes.

Fig. 1

Adaptive treatment strategy example trial design. VAR = varenicline; BUP = bupropion; CTF = continue to follow; Q=quit, R=relapse; O1 denotes all of the pretreatment information at the beginning of stage 1, A1 is the treatment assigned at stage 1, O2 denotes all of the intermediate observations made on the patient prior to treatment at the beginning of stage 2, A2 is the treatment assigned at stage 2, and Y is the primary outcome