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Why Smoking Cessation Why Smoking Cessation Should Be a Priority in HIV Should Be a Priority in HIV
Care Today…Care Today…
Why Smoking Cessation Why Smoking Cessation Should Be a Priority in HIV Should Be a Priority in HIV
Care Today…Care Today…
Alvaro Carrascal, MD, MPHOffice of the Medical DirectorAIDS InstituteAI is a Local Performance Site of the NY/NJ AETC
ObjectivesObjectivesObjectivesObjectives
Review the changing paradigm of HIV Review the changing paradigm of HIV diseasedisease
Review the association between smoking Review the association between smoking and HIVand HIV
Describe the importance of addressing Describe the importance of addressing tobacco use among PLWHAtobacco use among PLWHA
HIV Disease: Changing HIV Disease: Changing ParadigmParadigm
HIV Disease: Changing HIV Disease: Changing ParadigmParadigm
Reduced mortalityReduced mortality
Chronic diseaseChronic disease PLWH/AIDS living longer, healthier and more PLWH/AIDS living longer, healthier and more
productive livesproductive lives
Changing morbidity/mortalityChanging morbidity/mortality Cancer, CVD, diabetes, liver disease, etc.Cancer, CVD, diabetes, liver disease, etc.
55615561 pats., HOPS, 1996-2002pats., HOPS, 1996-2002
19961996 20022002 DeathsDeaths
6.3 /100 person-yrs 6.3 /100 person-yrs 2.2 2.2
OI rates: OI rates: 23 /100 person-yrs 23 /100 person-yrs 6 6
Reductions in MortalityReductions in MortalityReductions in MortalityReductions in Mortality
Palella FJ et al. Mortality and morbidity in the HAART era: Changing causes of death and disease in the HIV Outpatient study. 11th CROI; San Francisco, CA 2004. Abs. 872
Use of HAARTUse of HAARTUse of HAARTUse of HAART
0
20
40
60
80
100
1996 2002
HAART No HAART
% o
f pa
tient
s
Palella FJ et al. Mortality and morbidity in the HAART era: Changing causes of death and disease in the HIV Outpatient study. 11th CROI; San Francisco, CA 2004. Abs. 872
.. and Change in Causes of .. and Change in Causes of DeathDeath
.. and Change in Causes of .. and Change in Causes of DeathDeath
0102030405060708090
100
1996 2002
Non-HIV related HIV-related
% o
f de
aths
Palella FJ et al. Mortality and morbidity in the HAART era: Changing causes of death and disease in the HIV Outpatient study. 11th CROI; San Francisco, CA 2004. Abs. 872
Changes in Causes of DeathChanges in Causes of DeathSouthern Alberta, Canada, 1984-2003Southern Alberta, Canada, 1984-2003
Changes in Causes of DeathChanges in Causes of DeathSouthern Alberta, Canada, 1984-2003Southern Alberta, Canada, 1984-2003
0
5
10
15
20
25
30
35
Pre-HAART HAART
7%
32%
Cohort: 1987 patients Total # of deaths= 560
Krents, HB et al. Changing mortality rates and causes of death for HIV-infected individuals living in Southern Alberta, Canada, from 1984 to 2003. HIV Medicine 2005; 6:99–106
% o
f de
aths
, no
n-A
IDS
rel
ated
cau
ses
Increases in Non-AIDS Related Increases in Non-AIDS Related Causes of Death Causes of Death
Southern Alberta, Canada, 1984-2003Southern Alberta, Canada, 1984-2003
Increases in Non-AIDS Related Increases in Non-AIDS Related Causes of Death Causes of Death
Southern Alberta, Canada, 1984-2003Southern Alberta, Canada, 1984-2003
Causes of DeathCauses of Death 1984-961984-96 1997-031997-03
Accidental deathsAccidental deaths 2.2%2.2% 17%17%(drug overdose)(drug overdose)
Liver diseaseLiver disease <1<1 8.48.4
Non-HIV CancersNon-HIV Cancers <1<1 77
Krents, HB et al. Changing mortality rates and causes of death for HIV-infected individuals living in Southern Alberta, Canada, from 1984 to 2003. HIV Medicine 2005; 6:99–106
HIV-related and Non-HIV related HIV-related and Non-HIV related deaths among PLWHAdeaths among PLWHA
NYC 1988-2003NYC 1988-2003
HIV-related and Non-HIV related HIV-related and Non-HIV related deaths among PLWHAdeaths among PLWHA
NYC 1988-2003NYC 1988-2003
0%
20%
40%
60%
80%
100%
Perc
ent of
dea
ths
Non-HIV related deaths HIV-related deaths
Source: HIV Epidemiology Program 1st Quarter Report (Jan 2005), NYC Dept. of Health and Mental Hygiene
HAART
PLWHA Are Getting Older…PLWHA Are Getting Older…PLWHA Are Getting Older…PLWHA Are Getting Older…NY: HIV/AIDS hospital discharges among PLWHA NY: HIV/AIDS hospital discharges among PLWHA
50 years of age or older50 years of age or older
0
5
10
15
20
25
1994 2003
50 yo/olderSource: SPARCS database, NYSDOH
% o
f H
IV/A
IDS
dis
char
ges
PLWHA Are Getting Older…PLWHA Are Getting Older…PLWHA Are Getting Older…PLWHA Are Getting Older…
02468
101214161820
1993 2002
50 yo/older
NY: Medicaid Recipients with HIV/AIDS, NY: Medicaid Recipients with HIV/AIDS, Age 50+Age 50+
Source: Medicaid Claims database
% o
f H
IV/A
IDS
rec
ipie
nts
Changing MorbidityChanging MorbidityCardiovascular DiseasesCardiovascular Diseases
Changing MorbidityChanging MorbidityCardiovascular DiseasesCardiovascular Diseases
Prospective observational cohort
23,468 HIV+ pats,
Incidence of myocardial infarction (MI) increased by an average of 26% per year of exposure to CART, over the first 6 years of exposure
The D:A:D Study Group. Combination antiretroviral therapy and the risk of myocardial infarction. N Engl J Med 2003; 349:1993–2003
Incidence of MI according to the duration of exposure to CART
The Writing Committee of the D:A:D Study Group. Cardio- and cerebrovascular events in HIV-infected persons. AIDS 2004; 18:1811–1817
Myocardial infarction Among Myocardial infarction Among Patients with HIV InfectionPatients with HIV Infection
Myocardial infarction Among Myocardial infarction Among Patients with HIV InfectionPatients with HIV Infection
0
0.5
1
1.5
2
2.5
3
3.5
1993 1994 1995 1996 1997 1998 1999 2000 2001 2002
Ra
te p
er
10
00
pa
tien
t-yr
s
Holmberg et al. Trends in rates of myocardial infarction among patients with HIVN Engl J Med 2004; 350:730-731
0
100
200
300
400
500
600
700
800
1994 1995 1996 1997 1998 1999 2000 2001 2002
per 1
00,0
00 H
IV/A
IDS
disc
harg
es
Acute Myocardial Infarction
NY: Discharges among PLWHA
Source: SPARCS database, NYSDOH
“Cigarette smoking is the most important modifiable cardiovascular risk factor among HIV-infected patients.”
Greenspoon, S. Carr, A. Cardiovascular risk and body-fat abnormalities in HIV-infected adults. N Engl J Med 2005; 352:48–62
“Cessation of smoking is more likely to reduce cardiovascular risk than either the choice of antiretroviral therapy or the use of any lipid-lowering therapy.”
Greenspoon, S. Carr, A. Cardiovascular risk and body-fat abnormalities in HIV-infected adults. N Engl J Med 2005; 352:48–62
“..I’m doing pretty well. I think my chances are better of going of a heart attack than of AIDS. My biggest problem now is , What do I do when I retire?”
James Cadenhead
Infected with HIV for 18 years. Has had Hep B, C, toxoplasmosis.
New York Times, Aug. 17, 2004
Trends in AIDS-Defining and Non–AIDS-Defining Malignancies among HIV-Infected Patients 1989–2002
Trends in AIDS-Defining and Non–AIDS-Defining Malignancies among HIV-Infected Patients 1989–2002
0
5
10
15
20
25
30
35
40
89-96 97-02
ADM non-ADM
Ca s
es p
er 1
000
p at-
year
s
Years
Bedimo, R et al. Trends in AIDS-defining and non-AIDS-defining malignancies among HIV-infected patients: 1989-2002. Clin Inf Dis 2004;39:1380-1384
0
25
50
75
100
125
150
1994 1995 1996 1997 1998 1999 2000 2001 2002
Pe
r 1
00
,00
0 H
IV/A
IDS
dis
cha
rge
s
Cancers of the larynx and oropharynxamong PLWHA discharged from hospitals in NY, 1994-2002
Cancers of the larynx and oropharynxamong PLWHA discharged from hospitals in NY, 1994-2002
Dis
char
ges
from
hos
pita
ls
Source: NY SPARCS
0
20
40
60
80
100
120
140
160
1993 1994 1995 1996 1997 1998 1999 2000 2001
Per
100,0
00 r
eci
pie
nts
with
HIV
/AID
S
Oropharynx Larynx
Source: NY Medicaid
Cancers of the larynx and oropharynxamong PLWHA, Medicaid recipients, NY, 1993-2001
Cancers of the larynx and oropharynxamong PLWHA, Medicaid recipients, NY, 1993-2001
0
100
200
300
400
500
600
700
800
1994 1995 1996 1997 1998 1999 2000 2001 2002
Per
100
,000
HIV
/AID
S d
isch
arge
s
Lung, TracheaSource: NY SPARCS
Cancers of the lung and trachea among PLWHA discharged from hospitals in NY, 1994-2002
Cancers of the lung and trachea among PLWHA discharged from hospitals in NY, 1994-2002
0
100
200
300
400
500
600
1993 1994 1995 1996 1997 1998 1999 2000 2001
Per
100,
000
reci
pien
ts w
ith H
IV/A
IDS
Lung&TracheaSource: NY Medicaid Claims database
Cancers of the lung and tracheaamong PLWHA, Medicaid recipients, NY, 1993-2001
Cancers of the lung and tracheaamong PLWHA, Medicaid recipients, NY, 1993-2001
0
5
10
15
20
25
30
35
40
45
50
AIDS Cancer HCV CVD
Causes of death among HIV-Causes of death among HIV-infected adults in France, 2000infected adults in France, 2000Causes of death among HIV-Causes of death among HIV-
infected adults in France, 2000infected adults in France, 2000
Lewden C et al. Causes of death among HIV-infected adults in the era of potent antiretroviral therapy: emerging role of hepatitis and cancers, persistent role of AIDS. Int J Epidemiol 2005;34:121-130
N=964
% o
f all
deat
hs
Causes of death among HIV-Causes of death among HIV-infected adults in France, 2000infected adults in France, 2000Causes of death among HIV-Causes of death among HIV-
infected adults in France, 2000infected adults in France, 2000
Prevention, screening, and management of non-Hodgkin’s lymphoma and of non-AIDS related cancers, especially lung cancer, prevention of CVDs, and management of viral hepatitis should be considered public health priorities
Specific programs for smoking cessation should be developed for the HIV-infected
Lewden C et al. Causes of death among HIV-infected adults in the era of potent antiretroviral therapy: emerging role of hepatitis and cancers, persistent role of AIDS. Int J Epidemiol 2005;34:121-130
“Now that HAART-regimens have considerably improved the life expectancy in HIV-infected populations in industrialized countries, efforts to reduce smoking and alcohol consumption must be a priority in HIV medicine.”
Zwahlen M, Lundgren, JD. Commentary: Death in the era of potent antiretroviral therapy: shifting causes, new challenges. Int J Epidemiol 2005;34:130-131
0
2
4
6
8
10
12
14
16
18
20
Anal Hodgkin's Liver
Testicular Melanoma Oropharyngeal
Lung Colorectal
Incidence Rate Ratios of Non-AIDS Incidence Rate Ratios of Non-AIDS Defining MalignanciesDefining Malignancies
1992-20021992-2002
Incidence Rate Ratios of Non-AIDS Incidence Rate Ratios of Non-AIDS Defining MalignanciesDefining Malignancies
1992-20021992-2002Incidence rate ratio Standardized HIV: Observed SEER
Patel P et al. Incidence of AIDS-defining and non-AIDS defining malignancies among HIV infected persons. CROI 2006
Incidence Rate Ratios of Non-AIDS Incidence Rate Ratios of Non-AIDS Defining MalignanciesDefining Malignancies
1992-20021992-2002
Incidence Rate Ratios of Non-AIDS Incidence Rate Ratios of Non-AIDS Defining MalignanciesDefining Malignancies
1992-20021992-2002
““The incidence of many non-ADM were The incidence of many non-ADM were significantly higher … suggesting that HIV-significantly higher … suggesting that HIV-infected persons are at higher risk of developing infected persons are at higher risk of developing certain cancerscertain cancers
In addition to encouraging tobacco cessation, In addition to encouraging tobacco cessation, health care providers should consider enhanced health care providers should consider enhanced monitoring for these malignancies in their HIV-monitoring for these malignancies in their HIV-infected patients.”infected patients.”
Patel P et al. Incidence of AIDS-defining and non-AIDS defining malignancies among HIV infected persons. CROI 2006
Lung Cancer in PLWHALung Cancer in PLWHALung Cancer in PLWHALung Cancer in PLWHA
5,238 pats., Moore Clinic, 1989-20035,238 pats., Moore Clinic, 1989-2003 19,061 person-years of follow up19,061 person-years of follow up 33 cases identified (85% current smokers 33 cases identified (85% current smokers
12% 12% former smokers)former smokers)
SIR Detroit gen. pop. = 4.7SIR Detroit gen. pop. = 4.7
US pop. = 6.9US pop. = 6.9Engels, EA et al. Elevated incidence of lung cancer among HIV-infected individuals. J Clin Oncol 2006; 24: 1383–88
Lung Cancer in PLWHALung Cancer in PLWHALung Cancer in PLWHALung Cancer in PLWHA
“Elevated incidence of lung cancer As people with HIV live longer and age,
clinicians should be alert to the possible diagnosis of lung cancer in HIV-inf. patients
Need to develop effective interventions to assist individuals in their attempts to quit smoking
Smoking might not entirely explain the excess of lung ca. among HIV-inf. persons, hence the need for research regarding pathogenesis”Engels, EA et al. Elevated incidence of lung cancer among HIV-infected individuals. J Clin Oncol 2006; 24: 1383–88
Chronic Bronchitis and EmphysemaChronic Bronchitis and Emphysemaamong PLWHA Discharged from among PLWHA Discharged from
Hospitals in NYHospitals in NY
Chronic Bronchitis and EmphysemaChronic Bronchitis and Emphysemaamong PLWHA Discharged from among PLWHA Discharged from
Hospitals in NYHospitals in NY
0
200
400
600
800
1000
1200
1400
1994 1995 1996 1997 1998 1999 2000 2001 2002
per 1
00,0
00 H
IV/A
IDS
dis
char
ges
Chronic Bronchitis Emphysema
Source: SPARCS database, NYSDOH
Oral HealthOral HealthOral HealthOral Health
HIV+ smokers are more likely to HIV+ smokers are more likely to developdevelop Oral candidiasisOral candidiasis PeriodontitisPeriodontitis Oral hairy leukoplakiaOral hairy leukoplakia CancersCancers
Oral HealthOral HealthOral HealthOral Health
HIV Cost and Services Utilization Study. HIV Cost and Services Utilization Study. National probability sample of HIV inf. Adults in National probability sample of HIV inf. Adults in the USthe US
Self-reported, 3 sets of interviewsSelf-reported, 3 sets of interviews Smokers were 62% more likely to report “oral Smokers were 62% more likely to report “oral
white patches” than non-smokerswhite patches” than non-smokers
Marcus, M. et al. Oral white patches in a national sample of medical HIV patients in the era of HAART. Community Dent Oral Epidemiol 2005; 33: 99–106
Minkoff H et al. Relationship between smoking and Human Papillomavirus infections in HIV-infected and -uninfected women. J Infect Dis 2004;189:1821-8
Impact of Smoking on Impact of Smoking on Outcome in the HIV Outcome in the HIV
InfectedInfected
Impact of Smoking on Impact of Smoking on Outcome in the HIV Outcome in the HIV
InfectedInfected
Women: Cigarrette Smoking Women: Cigarrette Smoking and HIV Prognosis in the and HIV Prognosis in the
HAART EraHAART Era
Women: Cigarrette Smoking Women: Cigarrette Smoking and HIV Prognosis in the and HIV Prognosis in the
HAART EraHAART Era
Feldman JG, Minkoff H et al. The association of cigarette smoking with HIV prognosis among women in the HAART era—A report from the Women’s Interagency HIV Study. Am J Public Health 2006;96(6):1-6
Women: Cigarrette Smoking Women: Cigarrette Smoking and HIV Prognosis in the and HIV Prognosis in the
HAART EraHAART Era
Women: Cigarrette Smoking Women: Cigarrette Smoking and HIV Prognosis in the and HIV Prognosis in the
HAART EraHAART Era
Feldman JG, Minkoff H et al. The association of cigarette smoking with HIV prognosis among women in the HAART era—A report from the Women’s Interagency HIV Study. Am J Public Health 2006;96(6):1-6
Cumulative percentage remaining free from an AIDS-defining condition, by smoking status before HAART initiation
Impact of Cigarette Smoking Impact of Cigarette Smoking on Mortality and QOL Among on Mortality and QOL Among
PLWHAPLWHA
Impact of Cigarette Smoking Impact of Cigarette Smoking on Mortality and QOL Among on Mortality and QOL Among
PLWHAPLWHA 867 HIV+ from Veterans Aging Cohort 3 Site 867 HIV+ from Veterans Aging Cohort 3 Site
StudyStudy 63% current smokers, 22% former smokers63% current smokers, 22% former smokers Current smokers had highest VL (compared to Current smokers had highest VL (compared to
form. or never smokers. p=.001)form. or never smokers. p=.001) Smoking was strongly associated with increased
respiratory symptoms (cough, dyspnea), noninfectious pulmonary disease (COPD &/or asthma), and bacterial pneumonia
Crothers, K et al. The impact of cigarette smoking on mortality, quality of life, and comorbid illness among HIV-positive veterans. J Gen Intern Med 2005;20:1142-45
0
1
2
3
4
5
6
Impact of Cigarette Smoking on Impact of Cigarette Smoking on Mortality Mortality
Impact of Cigarette Smoking on Impact of Cigarette Smoking on Mortality Mortality
Una
djus
ted
mor
talit
y ra
te p
er 1
00 p
erso
n-ye
ars
Smokers Never smokers
After adjusting for age, race/ethnicity, baseline CD4 cell count, VL, hemoglobin, illegal drug/alcohol use, mortality was significantly increased in current smokers compared with never smokers (hazard ratio [HR] 1.99, 95% CI1.03 to 3.86).
Crothers, K et al. The impact of cigarette smoking on mortality, quality of life, and comorbid illness among HIV-positive veterans. J Gen Intern Med 2005;20:1142-45
Cigarette Smoking and QOLCigarette Smoking and QOLCigarette Smoking and QOLCigarette Smoking and QOL
36
37
38
39
40
41
42
43
44
45
Smokers Former smokers Never smokers
N=549
N=189
N=129
QO
L
Crothers, K et al. The impact of cigarette smoking on mortality, quality of life, and comorbid illness among HIV-positive veterans. J Gen Intern Med 2005;20:1142-45
How Serious is the How Serious is the Problem?Problem?
How Serious is the How Serious is the Problem?Problem?
Prevalence of smoking among people with HIV Prevalence of smoking among people with HIV --- estimated to be --- estimated to be higherhigher than among the than among the general populationgeneral population
New England clinics: More than 70% of HIV+ New England clinics: More than 70% of HIV+ smokesmoke
Swiss HIV Cohort StudySwiss HIV Cohort Study 72% are current/former smokers72% are current/former smokers 96% among IDUs96% among IDUs
Niaura R et al. Smoking among HIV-positive persons. Ann Behav Med 1999; 21(Suppl):S116
Clifford, GM et al. Cancer risk in the Swiss HIV Cohort Study: Associations with immunodeficiency, smoking and Highly Active Antiretroviral Therapy. J Natl Cancer Inst 2005;97:425-432
New YorkNew YorkNew YorkNew York
482 HIV+ Medicaid recipients, NYC482 HIV+ Medicaid recipients, NYC Age: 22-75 Age: 22-75 59% males59% males 53% African Americans53% African Americans
30% Latinos30% Latinos HS education or less : 87%HS education or less : 87%
66% current smokers (mean=16 cig./day)66% current smokers (mean=16 cig./day) 18% former smokers18% former smokers Current smokersCurrent smokers
Greater use of illicit substancesGreater use of illicit substances Lower state of healthLower state of health Lower perceived health risk of continued smokingLower perceived health risk of continued smoking
Burkhalter, JE et al. Tobacco use and readiness to quit smoking in low-income HIV-infected persons. Nicotine Tob Res 2005; 7(4):511-522
3-page self-administered survey
Input from NYSDOH Tobacco Control Program Instruments used to measure tobacco use
Survey collected: Demographics Current and past tobacco use. Frequency. Perceptions regarding tobacco use Cessation history. Intentions/readiness to quit
Smoking Prevalence among Smoking Prevalence among PLWHA Receiving Care in NYSPLWHA Receiving Care in NYS
20052005
NYS DOH AIDS InstituteNYS DOH AIDS Institute
Upstate NY RegionUpstate NY Region Erie County Medical Center*Erie County Medical Center* Nassau University*Nassau University* Strong Memorial Hospital*Strong Memorial Hospital* SUNY Syracuse*SUNY Syracuse* United Health Services*United Health Services* Westchester County Medical Westchester County Medical
Center*Center*
* Designated AIDS Care Center* Designated AIDS Care Center**Adult Day Health Center**Adult Day Health Center
NYC RegionNYC Region Bronx Lebanon*Bronx Lebanon* Harlem United**Harlem United** Housing Works 13Housing Works 13thth Street** Street** Housing Works 98Housing Works 98thth Street** Street** NY Hospital of Queens*NY Hospital of Queens* PROMESA**PROMESA** Saint Vincent Medical Center*Saint Vincent Medical Center* SUNY Brooklyn*SUNY Brooklyn* Village Center**Village Center**
NYS DOH AIDS InstituteNYS DOH AIDS Institute
Smoking Prevalence among Smoking Prevalence among PLWHA Receiving Care in NYSPLWHA Receiving Care in NYS
20052005
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Hisp Afr.Amer White Other
NYS DOH AIDS InstituteNYS DOH AIDS Institute
Target Sample: Target Sample: 12281228
Surveys Surveys completed: 1094completed: 1094
Return rate: 89%Return rate: 89%
Smoking Prevalence among Smoking Prevalence among PLWHA Receiving Care in NYSPLWHA Receiving Care in NYS
20052005
10010010771077TotalTotal
16.316.3175175Never UsedNever Used
24.524.5264264Used in the PastUsed in the Past
59.259.2638638Currently UseCurrently Use%%NNUse StatusUse Status
NYS DOH AIDS Institute, OMD/OPERNYS DOH AIDS Institute, OMD/OPER
Smoking Prevalence among Smoking Prevalence among PLWHA Receiving Care in NYSPLWHA Receiving Care in NYS
20052005
Percentage Correct on Smoking Percentage Correct on Smoking Knowledge StatementsKnowledge Statements
Percentage Correct on Smoking Percentage Correct on Smoking Knowledge StatementsKnowledge Statements
64%64%Smoking isn’t any more dangerous for HIV positive Smoking isn’t any more dangerous for HIV positive individuals than it is to people without HIV. individuals than it is to people without HIV. N=1027 N=1027
63%63%
Because it takes many years for the effects of smoking to Because it takes many years for the effects of smoking to occur, smoking isn’t a serious health concern for HIV positive occur, smoking isn’t a serious health concern for HIV positive people. people. N=1027 N=1027
14%14%Nicotine is a cause of cancerNicotine is a cause of cancer. . N=1023N=1023
56%56%
If a person has smoked a pack of cigarettes a day for more If a person has smoked a pack of cigarettes a day for more than 20 years, there is little benefit to quitting smoking.than 20 years, there is little benefit to quitting smoking.
N=1039N=1039
% Correct% CorrectSmoking Knowledge StatementsSmoking Knowledge Statements
NYS DOH AIDS Institute, OMD/OPERNYS DOH AIDS Institute, OMD/OPER
Willingness to QuitWillingness to QuitWillingness to QuitWillingness to Quit
Stopped smoking for one day or longer Stopped smoking for one day or longer during the past 12 months: during the past 12 months:
Currently interested in quitting: Currently interested in quitting:
64%
74%
NYS DOH AIDS Institute, OMD/OPERNYS DOH AIDS Institute, OMD/OPER
How Big is the Problem?How Big is the Problem?How Big is the Problem?How Big is the Problem?
HUGE! HUGE! In NY, smoking is 3 times higher among In NY, smoking is 3 times higher among
PLWHA than among the general pop. PLWHA than among the general pop.
HIV+ populations include the following HIV+ populations include the following overlapping conditionsoverlapping conditions Substance useSubstance use Mental healthMental health Poverty, low educational attainmentPoverty, low educational attainment
2004 Surgeon General Report 2004 Surgeon General Report on Smoking on Smoking
2004 Surgeon General Report 2004 Surgeon General Report on Smoking on Smoking
Updates the health effects of smokingUpdates the health effects of smoking
Identifies substantial number of diseases that were Identifies substantial number of diseases that were not previously associated with smokingnot previously associated with smoking Cancer of the stomach, uterine cervix, pancreas, kidneyCancer of the stomach, uterine cervix, pancreas, kidney Acute myeloid leukemiaAcute myeloid leukemia PneumoniaPneumonia Abdominal aortic aneurysmAbdominal aortic aneurysm CataractsCataracts PeriodontitisPeriodontitis
Single most preventable cause of death and illnessSingle most preventable cause of death and illness
ConclusionsConclusionsConclusionsConclusions Significant changes in mortality and morbidity Significant changes in mortality and morbidity
among people with HIVamong people with HIV
PLWHA are living longer and increasingly PLWHA are living longer and increasingly becoming ill or dying of non HIV- related becoming ill or dying of non HIV- related conditionsconditions
Smoking is highly prevalent among PLWHASmoking is highly prevalent among PLWHA
Smoking cessation should be a priority in the Smoking cessation should be a priority in the medical management of PLWHAmedical management of PLWHA
ConclusionsConclusionsConclusionsConclusions Significant, and immediate, benefits for HIV+ Significant, and immediate, benefits for HIV+
individuals can be achieved by quittingindividuals can be achieved by quitting
Significant public health benefits can be Significant public health benefits can be derived from reducing smoking among derived from reducing smoking among PLWHAPLWHA
To further improve survival and quality of life To further improve survival and quality of life for PLWHA, we MUST promote smoking for PLWHA, we MUST promote smoking cessationcessation