Tobacco Use More Common Among HIV Population, Increases Risk of Death

Tobacco use among individuals with HIV is more than twice as likely to cause death than the infection itself, according to a study published in The Lancet Global Health.

For the study, investigators used data from the Demographic and Health Surveys of 28 low- and middle-income countries conducted between 2004 and 2014.

Within low- and middle-income countries—–particularly in the African region––men with HIV are 41% more likely to use tobacco and women are 36% more likely to use tobacco compared with their HIV-negative counterparts. Tobacco use included snuff, smoking, and chewing tobacco.

For only smoking tobacco, 46% of men with HIV and 90% of women with HIV were more likely to smoke than HIV-negative individuals. The authors noted that the proportion of individuals with HIV who smoke was higher among men than women.

“In high-income settings, the proportion of HIV-positive individuals who smoke has also been shown to be higher than among HIV-negative individuals of the same sex and age,” said investigator Dr Noreen Mdege, New York University’s Department of Health Sciences. “Our findings confirm that this trend is the same for low- and middle-income countries, where the burden of HIV and tobacco-related illnesses is greatest.”

Because of the emergence of antiretrovirals, many patients with HIV will only lose approximately 5 years of life due to their disease; however, if they smoke, they may lose as much as 12 years of life.

The specific reasons for why tobacco use is significantly higher among individuals with HIV remains uncertain. The investigators said that more research needs to be done to determine why.

“A few factors could be considered as part of our ongoing work, such as the use of alcohol and other drugs together with tobacco, as well as mental health issues, such as depression, and coping with HIV-related symptoms or drug [adverse events],” Mdege said. “It could also be due to the misconception that HIV is a death penalty, which of course, it is not.”

The investigators also found disparities among men and women in the way tobacco is consumed. Women tended to use smokeless tobacco, such as snuff or chewing tobacco, than smoke.

Reasons for these differences could be due to social or cultural norms, according to the authors. In many low- and middle-income countries, smoking is considered less socially acceptable among women compared with men, whereas snuff or chewing tobacco is more acceptable.

“Our main concern, however, is that interventions that are used commonly throughout the world for smoking cessation do not appear to make any difference to tobacco smoking among HIV-positive individuals,” Mdege said. “This suggests that we need to tailor smoking cessation interventions to the unique needs of this population in order to tackle this issue.”

The next step of the study will focus on understanding the differences in the way tobacco is used among patients with HIV compared with the general population, and any factors that may influence tobacco use within HIV-positive patients.

“This way, we will be able to develop tailored interventions that are effective on tackling the root causes of tobacco use as well as how it is used among HIV-positive individuals,” Mdege concluded.