icon-    folder.gif   Conference Reports for NATAP  
  16th CROI
Conference on Retroviruses and Opportunistic Infections Montreal, Canada
February 8-11, 2009
Back grey_arrow_rt.gif
Helping HIV Patients Stop Smoking--Worthy Goal But Tough Work
  16th Conference on Retroviruses and Opportunistic Infections,
February 8-11, 2009, Montreal
Mark Mascolini
This conference proved particularly rife in studies tracing links between smoking and death in people with HIV. But the one study that tried to get HIV-infected people to stop smoking met with little success [1]. Results with the Positive Paths approach did offer some clues to building better antismoking programs.
Depending on the study consulted, between 47% and 70% of HIV-infected people smoke, well above the US national average of 20%, according to principal investigator Karen Tashima. She suggested that overlapping HIV and smoking risk factors in the US population account for the high smoking rate, including poverty, substance abuse, and black race.
Tashima and colleagues recruited HIV-infected people from eight outpatient clinics in Rhode Island. Enrollees did not have to claim they wanted to quit smoking. The study did not enroll anyone under 18 years old, pregnant women, of anyone with a contraindication to using the nicotine patch.
The investigators randomized 232 people to a standard-of-care approach to smoking cessation and 212 to Positive Paths. Everyone received brief counseling from their physician about quitting and enough nicotine patches to last for 8 weeks. The standard-of-care control group had two 3- to 4-minute sessions to review quitting plans and self-help quitting materials. The Positive Paths group had four 30-minute sessions covering topics like goal setting and the personal responsibility for change. Everyone in this group also got a phone call on their target quitting day.
Study participants averaged 42 years in age, 63% were men, 52% white, 18% black, and 16% Hispanic. They smoked an average 18 cigarettes a day. After 6 months, 166 people (72%) remained in the standard-of-care group and 152 (72%) in the Positive Paths group--retention rates clearly pointing to the hurdles faced by such programs. About three quarters of study participants set a quit date, and two thirds used the nicotine patch.
The study defined quitting as abstinence based on self-report for the past 7 days confirmed by a 24-hour biochemical test. A 6-month intention-to-treat analysis determined that 9% in the Positive Paths group and 10% in the standard-of-care control group quit. A 6-month available-case analysis found similar quitting rates of 12% with Positive Paths and 14% with the standard of care.
Both the available-case and intention-to-treat analyses found a significantly higher quitting rate among Hispanics than in other racial/ethnic groups (25% available case, P = 0.02, and 19% intention-to-treat, P = 0.01). Tashima suggested that a reinforcing social network may account for the significantly greater quitting rate among Hispanics.
Multivariate analysis identified several significant predictors of quitting at 6 months, including a high motivation to quit (P = 0.04), a lower Fagerstrom (nicotine dependence) score (P = 0.02), and being Hispanic-American versus European-American (P = 0.02). No one who declined to use the nicotine patch quit, and no blacks in the standard-of-care group quit.
Tashima added that brief and frequent healthcare contacts focused on nicotine replacement enhanced the likelihood of quitting. Thus, she suggested, a longer intervention with more contacts could prove more successful.
1. Tashima K, Niaura R, Richardson E, Stanton C, De Dios M, Kojic M. Positive Paths: a motivational intervention for smoking cessation among HIV+ smokers. 16th Conference on Retroviruses and Opportunistic Infections, February 8-11, 2009, Montreal. Abstract 148.