A smoking cessation programme in HIV-infected individuals: a pilot study.
BACKGROUND
Antiretroviral therapy (ART) is a risk factor for cardiovascular disease (CVD) and smoking the most important modifiable cardiovascular risk factor.


METHODS
We prospectively evaluated a smoking cessation programme (SCP) in HIV-infected individuals (intervention: counselling and nicotine replacement therapy). Primary endpoint was the smoking cessation rate at 12 months; secondary endpoints were CVD morbidity and mortality. Controls were a not randomized control group of smokers not participating in the SCP.


RESULTS
Four-hundred and seventeen of 680 (61%) patients were smokers, and 34 of these participated in the SCP. Of these 34 individuals, 82% were male, the median age was 43 years, prior AIDS was recorded in 29%, and depressive disorder was recorded in 18/%. Twenty-five (74%) patients were receiving ART. Additional risk factors were dyslipidaemia (68%), a prior cardiovascular event (24%), hypertension (1 5%), and a family history of CVD in 2/34 (6%) individuals. According to the Framingham equation, the 10-year risk of CVD was higher in SCP participants than in controls (11.2% versus 8.5%, P=0.06). At termination of the SCP, 17/34 (50%) individuals had stopped smoking compared with 57/383 (15%) controls. Self-reported smoking abstinence for a12 months was 13/34 (38%) in the intervention group and 27/383 (7%) in the control group (odds ration 6.2, 95% confidence interval 2.8-14.3). During the follow-up, two SCP participants and 4 controls experienced a myocardial infarction. One patient in the control group died of CVD.


CONCLUSIONS
SCP in HIV-infected individuals is feasible and should be encouraged. The long-term impact of smoking cessation on CVD morbidity and mortality should be evaluated in comparative trials.
Elzi
Luigia
L
Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel.
Spoerl
David
D
Voggensperger
Jacqueline
J
Nicca
Dunja
D
Simcock
Mathew
M
Bucher
Heiner C
HC
Spirig
Rebecca
R
Battegay
Manuel
M
D000328:Adult; D002318:Cardiovascular Diseases / Q000401:mortality / Q000503:physiopathology; D003376:Counseling; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D008297:Male; D008875:Middle Aged; D018722:Nicotinic Agonists / Q000008:administration & dosage / Q000627:therapeutic use*; D010865:Pilot Projects; D016540:Smoking Cessation / Q000379:methods; D014029:Tobacco Use Disorder / Q000628:therapy*
D018722:Nicotinic Agonists