Improved clinical outcomes among persons with HIV who quit smoking

ABSTRACT

Quitting smoking among people living with HIV/AIDS (PLWHA) is a priority. However, PLWHA and clinicians working with PLWHA are reluctant to use tobacco use treatments out of concern that smoking cessation can diminish anti-retroviral therapy (ART) adherence and quality of life (QoL) and increase psychiatric symptoms. This secondary analysis from a placebo-controlled varenicline trial for tobacco dependence among PLWHA (N = 179) examined if smoking cessation at the end of treatment (EOT) was associated with changes in ART adherence, QoL, anxiety and depression symptoms, and varenicline side effects. ART adherence was not affected by smoking cessation (p > 0.05), remaining ≥98% for all participants. Across 8 QoL subscales, 7 remained unchanged over time across smokers and abstainers; side effects were not associated with cessation. Controlling for baseline smoking rate, adherence to varenicline/placebo and counseling, and treatment arm, participants who had quit smoking at EOT reported a significant reduction in depression (β = −1.657, 95% CI: −2.893, −0.422, p = .009) and anxiety (β = −1.434, 95% CI: −2.812, −0.56, p = .041) and increased life satisfaction (β = 0.88, 95% CI: 0.21, 3.275, p = .027). When PLWHA quit smoking they may not experience adverse clinical outcomes including ART non-adherence and may experience beneficial psychological effects, supporting the use of FDA-approved smoking cessation treatments among PLWHA.

KEYWORDS:

• Tobacco
• HIV
• smoking
• varenicline
• quality of life
• outcomes

Disclosure statement

Dr. Schnoll received medication and placebo free from Pfizer and has provided consultation to Pfizer. Dr. Schnoll has provided consultation to GlaxoSmithKline and CuraLeaf. Dr. Gross serves on a DSMB for a Pfizer medication unrelated to smoking or HIV. No other conflicts are declared.

Additional information

Funding

This work was supported by National Institutes of Health [grant number K24 DA045244 and R01 DA033681] and University of Pennsylvania Center for AIDS Research [P30 AI045008] and Penn Mental Health AIDS Research Center [P30 MH097488]. Pfizer provided the medication and placebo supply. National Institute of Allergy and Infectious Diseases; National Institute of Mental Health; National Institute on Drug Abuse.