COPD in People with HIV: Epidemiology, Pathogenesis, Management, and Prevention Strategies

Figures & data

Figure 1 Drivers of COPD in PWH.

Figure 2 Chest radiograph from person with HIV and COPD demonstrating hyperinflation, flattened diaphragms, and bilateral bullous lung disease (Courtesy of Laurence Huang, MD).

Figure 3 Chest computed tomography from the same person with HIV and COPD demonstrating large, bilateral bullae. This individual eventually underwent bullectomy with dramatic improvement in his respiratory status (Courtesy of Laurence Huang, MD).

Table 1 Summary of Randomized Controlled Trials of Smoking Cessation in People with HIV

Author	Year	Intervention/Control	Key Findings
Vidrine, et al^Citation242,Citation243	2006a, b	Intervention: cell phone counseling intervention in 8 sessions + advice to quit +NRT* + self-help material Control: advice to quit + NRT + self-help materials	Significant difference in abstinence prevalence (36.8% vs 10.3%), OR for abstinence = 5.1 (95% CI 1.5–17.4, p =0.009)
Ingersoll, et al^Citation245	2009	Intervention: motivational interviewing +NRT Control: self-guided reading + NRT	No between-group difference; significant decline in mean CO level and number of cigarettes/ day (17.3-> 6.2)
Lloyd-Richardson, et al^Citation246	2009	Intervention: motivational interviewing (4 sessions), quit-day counseling call, NRT Control: two brief sessions with a health educator, self-help materials and NRT	No significant difference in abstinence between groups (12%, 9%, 9% vs 13%, 10%, 10% in treatment vs control groups)
Moadel, et al^Citation247	2012	Intervention: 8 weekly, 90 minute in-person sessions designed to ‘address the needs and concerns of HIV-infected smokers’ + NRT Control: quit smoking brochure, brief cessation counseling (<5 min) +NRT	● 19.2 vs 9.7% quit rate in intention-to-treat analysis, p=0.11; as-treated analysis OR for quitting 3.55 (95% CI 1.04–12.0) ● Treatment arm with significant decrease in number of cigarettes smoked daily (6.6 less vs 2.6, p=0.02) and improved self-efficacy and motivation to quit
Cropsey, et al^Citation248	2013	Intervention: 8 weeks of NRT + counseling using SBIRT framework Control: no smoking cessation-specific intervention	Treatment group with significantly lower nicotine dependence (p=0.01), lower urge to smoke (p=0.01). Non-significant decrease in number of cigarettes smoked per day (p=0.13)
Gritz, et al^Citation241	2013	Intervention: usual care + 11 cell phone-based counseling sessions over 3 months Control: advice to quit, self-help materials and NRT	Intervention group had 2.41 times the odds of staying abstinent (p=0.049) at 3 months with diminishing effect after 3 months
Humfleet, et al^Citation250	2013	Arm 1 = individual counseling + NRT Arm 2 = computer-based Internet smoking cessation program + NRT Arm 3 = self-help + NRT	No statistically significant differences in abstinence between groups over time (24–29% at week 12, 19.7–25.6% at week 52) but overall decline in cigarette use over time
Manuel, et al^Citation251	2013	Intervention: one motivational interviewing session Control: prescribed advice All female participants	No significant differences in abstinence between groups (3 vs 0 participants, p=0.067) Intervention group had a significant decrease in cigarettes smoked per day compared to control (15.5 to 7, compared to 16.7 to 15.8 in control, p<0.05)
Shuter, et al^Citation226	2014	Intervention: 8 session, 7-week targeted tobacco treatment online program + NRT Control: brief advice to quit + self-help brochure +NRT	10% of intervention vs 4.3% control group participants achieved end point (p=0.33); among those who completed full course, more women achieved abstinence (30.8% vs 17.9%)
Cropsey, et al^Citation249	2015	Intervention: 12-week pharmacotherapy-based algorithm (stepwise) Control: ‘treatment as usual’-baseline smoking cessation counseling (20 min)	At 1 month, 10 vs 6 cig/day reduction and 50 vs 38% quit attempts across follow-up
Pengpid, et al^Citation252	2015	Arm 1: brief counseling (tobacco + alcohol) for dual substance users Arm 2: brief counseling (tobacco only) for dual substance users Arm 3: brief counseling (alcohol only) for dual substance users	Tobacco only control arm outperformed joint intervention on smoking outcomes (eg, tobacco abstinence at 6 months 49% vs 17.7%); overall tobacco and alcohol use declined significantly on follow-up in all three arms
Stanton, et al^Citation239	2015	Intervention: 4 in-person sessions of tailored intervention +NRT Control: 2 in-person sessions of brief advice (‘enhanced standard of case’) + NRT Latino/a participants only	Abstinence was not significantly different at 6 and 12 months (8 vs 11%, and 6 vs 7%)
Tseng, et al^Citation240	2017	Arm 1: 12 weeks of varenicline + text message support cell phone-delivered adherence-focused motivational and behavioral therapy Arm 2: 12 weeks of varenicline + text message support Control (Arm 3): 12 weeks of varenicline	Arm 1 with significantly higher abstinence rate at week 8 (17.7 vs 5.7 vs 3.7%, p=0.03) and borderline significantly higher (15.7 vs 5.7 vs 3.7%, p=0.07) at week 12 compared to the other groups ; varenicline adherence decreased significantly over the course of the study in all arms (OR 0.09, p<0.001)
Kim, et al^Citation218	2018	Intervention: eight 30-minute weekly counseling sessions via video call+ NRT Control: eight 30-minute weekly counseling sessions via telephone call + NRT Female participants only	Video arm significantly more likely to maintain abstinence at 6 months (p<0.05)
Mercie, et al^Citation253	2018	Intervention: Varenicline + face-to-face counseling x12 weeks Control: placebo + face-to-face counseling x 12 weeks	Significantly higher rates of abstinence in intervention arm (15% vs 8%; aOR 2.5, 95% CI 1.0–6.1; p=0.041), higher continuous abstinence (18% vs 7%, aOR 2.7; 95% CI 1.1–6.5; p=0.029)
Mussulman, et al^Citation254	2018	Intervention: ‘warm handoff’ for hospitalized PWH who smoke – staff called quit line for enrollment/counseling at bedside Control: fax-referred to quit line on day of discharge from hospital	45.5% vs 14.3% verified abstinence rates (p=0.18)
O’Cleirigh, et al^Citation225	2018	Intervention: 1 psychoeducation session + 9 weekly 1-hour cognitive behavior therapy for smoking cessation and anxiety/depression + NRT Control: 1 psychoeducation session + 4 brief weekly check-in sessions + NRT	Significantly higher rates of abstinence at end of treatment (59% vs 9%, p<0.001) and at 6 months post-intervention (46 vs 5%, p<0.001)
Ashare, et al^Citation255	2019	Intervention: varenicline x 12 weeks + 6 smoking cessation counseling sessions Control: placebo x 12 weeks + 6 smoking cessation counseling sessions	At 12 weeks, abstinence significantly higher with varenicline (28.1 vs 12.1%, OR 4.54, 95% CI 1.83–11.25; p=0.001) but not at 24 weeks (14.6 vs 10%). Continuous abstinence significantly better in treatment group weeks 9–12 (23.6 vs 10%, OR 4.65, 95% CI 1.71–12.67; p=0.003), but effect lost by week 24 (10.1 vs 6.7%)
Gryaznov, et al^Citation257	2020	Intervention: CO self-monitoring, mobile phone-based feedback, and app-based smoking cessation support, NRT Control: counseling by program physicians, NRT	14% vs 13% quit rate at 6 months (not statistically significant; could not recruit desired number of participants)
Kim, et al^Citation220	2020	Intervention: screening of movie in which women with HIV discuss quitting smoking, 8 live video counseling sessions + NRT Control: screening of movie of women with HIV talking about HIV infection, 8 live video counseling sessions + NRT Female participants only.	No significant difference in 7-day point prevalence abstinence at 3 months by both self-report and cotinine test (40.7 vs 15.4%) Significantly higher odds sustained abstinence in intervention group 3 months after quitting (OR 4.23, 95% CI 1.10–16.27)
Shuter, et al^Citation259	2020	Intervention: web-based + text message-based support/ quit program (42 days)+NRT Control: brief quit advice + NRT	No difference in quit rate between arms: 10.4% vs 9.6% (OR 1.09, 95% CI 0.3–4.04; p=1.0), number of quit attempts (7.3 vs 5.9; p=0.28), and change in daily cigarette consumption (−7.5 vs −4.7, p=0.06)
Stanton, et al^Citation260	2020	Intervention: 8 session intensive group therapy + NRT Control: brief quit advice + NRT	Significantly higher quit rate in treatment group at 3 months (13 vs 6.6%, OR= 2.1, 95% CI 1.1–4.1; p=0.04) but not at 6 months (13% vs 13.3%) Barriers to cessation: lower education level, current cocaine use, high distress tolerance, prior NRT use
Schnall, et al^Citation261	2022	Intervention: Lumme Quit smoking app and smartwatch + control interventions Control: 8-week supply of NRT, 30 min smoking cessation counseling and weekly check-in calls	● 2 (12%) vs 3 (15%) with eCO-verified abstinence (p=0.77) ● 4 (24%) vs 6 (30%) with self-reported 7-day abstinence (p=0.66) ● Trend towards a decrease in eCO in both groups by the end of the study
Shuter, et al^Citation258	2022	Intervention: 8 online education sessions over 6 weeks + online platform and community access + NRT Control: access to AHA website online health-promotion intervention (only 1/7 on smoking) + NRT	Significantly higher quit rate in treatment group (14.9 vs 8.8%, OR 1.82, 95% CI 1.04–3.18; p=0.03)
Tindle, et al^Citation262	2022	Arm 1: active varenicline + placebo NRT + alcohol/tobacco counseling Arm 2: placebo varenicline + active NRT + alcohol/tobacco counseling Arm 3: active cytisine + placebo NRT + alcohol/tobacco counseling Arm 4: placebo cytisine + placebo NRT + alcohol/tobacco counseling	No significant difference between groups in heavy drinking days or abstinence from alcohol or tobacco; smoking cessation rate 15–19% in all groups

Abbreviation: *NRT, nicotine replacement therapy.

Vidrine DJ, Arduino RC, Gritz ER. Impact of a cell phone intervention on mediating mechanisms of smoking cessation in individuals living with HIV/AIDS. Nicotine Tob Res. 2006;8 Suppl 1(1):S103–108. doi:10.1080/14622200601039451

 PubMedGoogle Scholar

Vidrine DJ, Arduino RC, Lazev AB, Gritz ER. A randomized trial of a proactive cellular telephone intervention for smokers living with HIV/AIDS. AIDS. 2006;20(2):253–260. doi:10.1097/01.aids.0000198094.23691.58

 PubMed Web of Science ®Google Scholar

Ingersoll KS, Cropsey KL, Heckman CJ. A test of motivational plus nicotine replacement interventions for HIV positive smokers. AIDS Behav. 2009;13(3):545–554. doi:10.1007/s10461-007-9334-4

 PubMed Web of Science ®Google Scholar

Lloyd-Richardson EE, Stanton CA, Papandonatos GD, et al. Motivation and patch treatment for HIV+ smokers: a randomized controlled trial. Addiction. 2009;104(11):1891–1900. doi:10.1111/j.1360-0443.2009.02623.x

 PubMed Web of Science ®Google Scholar

Moadel AB, Bernstein SL, Mermelstein RJ, Arnsten JH, Dolce EH, Shuter J. A randomized controlled trial of a tailored group smoking cessation intervention for HIV-infected smokers. J Acquir Immune Defic Syndr. 2012;61(2):208–215. doi:10.1097/QAI.0b013e3182645679

 PubMed Web of Science ®Google Scholar

Cropsey KL, Hendricks PS, Jardin B, et al. A pilot study of screening, brief intervention, and referral for treatment (SBIRT) in non-treatment seeking smokers with HIV. Addict Behav. 2013;38(10):2541–2546. doi:10.1016/j.addbeh.2013.05.003

 PubMed Web of Science ®Google Scholar

Gritz ER, Danysh HE, Fletcher FE, et al. Long-term outcomes of a cell phone-delivered intervention for smokers living with HIV/AIDS. Clin Infect Dis. 2013;57(4):608–615. doi:10.1093/cid/cit349

 PubMed Web of Science ®Google Scholar

Humfleet GL, Hall SM, Delucchi KL, Dilley JW. A randomized clinical trial of smoking cessation treatments provided in HIV clinical care settings. Nicotine Tob Res. 2013;15(8):1436–1445. doi:10.1093/ntr/ntt005

 PubMed Web of Science ®Google Scholar

Manuel JK, Lum PJ, Hengl NS, Sorensen JL. Smoking cessation interventions with female smokers living with HIV/AIDS: a randomized pilot study of motivational interviewing. AIDS Care. 2013;25(7):820–827. doi:10.1080/09540121.2012.733331

 PubMed Web of Science ®Google Scholar

Shuter J, Morales DA, Considine-Dunn SE, An LC, Stanton CA. Feasibility and preliminary efficacy of a web-based smoking cessation intervention for HIV-infected smokers: a randomized controlled trial. J Acquir Immune Defic Syndr. 2014;67(1):59–66. doi:10.1097/QAI.0000000000000226

 PubMedGoogle Scholar

Cropsey KL, Jardin BF, Burkholder GA, Clark CB, Raper JL, Saag MS. An algorithm approach to determining smoking cessation treatment for persons living with HIV/AIDS: results of a pilot trial. J Acquir Immune Defic Syndr. 2015;69(3):291–298. doi:10.1097/QAI.0000000000000579

 PubMed Web of Science ®Google Scholar

Pengpid S, Peltzer K, Puckpinyo A, et al. Screening and concurrent brief intervention of conjoint hazardous or harmful alcohol and tobacco use in hospital out-patients in Thailand: a randomized controlled trial. Subst Abuse Treat Prev Policy. 2015;10(1):22. doi:10.1186/s13011-015-0018-1

 PubMedGoogle Scholar

Stanton CA, Papandonatos GD, Shuter J, et al. Outcomes of a tailored intervention for cigarette smoking cessation among latinos living with HIV/AIDS. Nicotine Tob Res. 2015;17(8):975–982. doi:10.1093/ntr/ntv014

 PubMed Web of Science ®Google Scholar

Tseng TY, Krebs P, Schoenthaler A, et al. Combining text messaging and telephone counseling to increase varenicline adherence and smoking abstinence among cigarette smokers living with HIV: a randomized controlled study. AIDS Behav. 2017;21(7):1964–1974. doi:10.1007/s10461-016-1538-z

 PubMed Web of Science ®Google Scholar

Kim SS, Darwish S, Lee SA, Sprague C, DeMarco RF. A randomized controlled pilot trial of a smoking cessation intervention for US women living with HIV: telephone-based video call vs voice call. Int J Womens Health. 2018;10:545–555. doi:10.2147/IJWH.S172669

 PubMed Web of Science ®Google Scholar

Mercie P, Arsandaux J, Katlama C, et al. Efficacy and safety of varenicline for smoking cessation in people living with HIV in France (ANRS 144 Inter-ACTIV): a randomised controlled phase 3 clinical trial. Lancet HIV. 2018;5(3):e126–e135. doi:10.1016/S2352-3018(18)30002-X

 PubMed Web of Science ®Google Scholar

Mussulman LM, Faseru B, Fitzgerald S, Nazir N, Patel V, Richter KP. A randomized, controlled pilot study of warm handoff versus fax referral for hospital-initiated smoking cessation among people living with HIV/AIDS. Addict Behav. 2018;78:205–208. doi:10.1016/j.addbeh.2017.11.035

 PubMed Web of Science ®Google Scholar

O’Cleirigh C, Zvolensky MJ, Smits JAJ, et al. Integrated treatment for smoking cessation, anxiety, and depressed mood in people living with HIV: a randomized controlled trial. J Acquir Immune Defic Syndr. 2018;79(2):261–268. doi:10.1097/QAI.0000000000001787

 PubMed Web of Science ®Google Scholar

Ashare RL, Thompson M, Serrano K, et al. Placebo-controlled randomized clinical trial testing the efficacy and safety of varenicline for smokers with HIV. Drug Alcohol Depend. 2019;200:26–33. doi:10.1016/j.drugalcdep.2019.03.011

 PubMed Web of Science ®Google Scholar

Gryaznov D, Chammartin F, Stoeckle M, et al. Smartphone app and carbon monoxide self-monitoring support for smoking cessation: a randomized controlled trial nested into the Swiss HIV cohort study. J Acquir Immune Defic Syndr. 2020;85(1):e8–e11. doi:10.1097/QAI.0000000000002396

 PubMed Web of Science ®Google Scholar

Kim SS, Lee SA, Mejia J, Cooley ME, Demarco RF. Pilot randomized controlled trial of a digital storytelling intervention for smoking cessation in women living with HIV. Ann Behav Med. 2020;54(6):447–454. doi:10.1093/abm/kaz062

 PubMed Web of Science ®Google Scholar

Shuter J, Kim RS, An LC, Abroms LC. Feasibility of a smartphone-based tobacco treatment for HIV-infected smokers. Nicotine Tob Res. 2020;22(3):398–407. doi:10.1093/ntr/nty208

 PubMed Web of Science ®Google Scholar

Stanton CA, Kumar PN, Moadel AB, et al. A multicenter randomized controlled trial of intensive group therapy for tobacco treatment in HIV-infected cigarette smokers. J Acquir Immune Defic Syndr. 2020;83(4):405–414. doi:10.1097/QAI.0000000000002271

 PubMed Web of Science ®Google Scholar

Schnall R, Liu J, Alvarez G, et al. A smoking cessation mobile app for persons living with HIV: preliminary efficacy and feasibility study. JMIR Form Res. 2022;6(8):e28626. doi:10.2196/28626

 PubMedGoogle Scholar

Shuter J, Chander G, Graham AL, Kim RS, Stanton CA. Randomized trial of a web-based tobacco treatment and online community support for people with HIV attempting to quit smoking cigarettes. J Acquir Immune Defic Syndr. 2022;90(2):223–231. doi:10.1097/QAI.0000000000002936

 PubMed Web of Science ®Google Scholar

Tindle HA, Freiberg MS, Cheng DM, et al. Effectiveness of varenicline and cytisine for alcohol use reduction among people with HIV and substance use: a randomized clinical trial. JAMA Netw Open. 2022;5(8):e2225129. doi:10.1001/jamanetworkopen.2022.25129

 PubMed Web of Science ®Google Scholar