1 / 57

HIV and Smoking: The Time to Quit is Now

HIV and Smoking: The Time to Quit is Now. HIV Disease: New Paradigm. Decreased mortality Increases in non-HIV related deaths Chronic disease PLWH/AIDS living longer, healthier and more productive lives Changing picture of mortality/morbidity Cancer, CVD, diabetes, liver disease, etc.

chun
Download Presentation

HIV and Smoking: The Time to Quit is Now

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. HIV and Smoking:The Time to Quit is Now

  2. HIV Disease: New Paradigm • Decreased mortality • Increases in non-HIV related deaths • Chronic disease • PLWH/AIDS living longer, healthier and more productive lives • Changing picture of mortality/morbidity • Cancer, CVD, diabetes, liver disease, etc.

  3. Changing Mortality

  4. Changes in Mortality • 5561pats., HOPS, 1996-2002 1996 2002 • Deaths • 6.3 /100 person-yrs 2.2 • OI rates: • 23 /100 person-yrs 6 • HAART use: • 48% 80% 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. Abstract 872

  5. Use of HAART % of patients 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. Abstract 872

  6. .. and Change in Causes of Death % of deaths 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. Abstract 872

  7. Non-AIDS Related Causes of DeathSouthern Alberta, Canada, 1984-2003 Cohort: 1987 patients Total # of deaths= 560 % of deaths, non-AIDS related causes 32% 7% 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

  8. Increases in non-AIDS Related Causes of Death Southern Alberta, Canada, 1984-2003 Causes of Death 1984-961997-03 • Accidental deaths 2.2% 17% (drug overdose) • Liver disease <1 8.4 • Non-HIV Cancers <1 7 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

  9. HIV-related and Non-HIV related deaths in PLWHA NYC 1988-2003 HAART Source: HIV Epidemiology Program 1st Quarter Report (Jan 2005), NYC Dept. of Health and Mental Hygiene

  10. Living Longer

  11. PLWHA Cohort, Southern Alberta PLWHA, 40 years of age or older Pre-HAART period (1984-96) 28% HAART period (1997-2003) 51% 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

  12. PLWHA Are Getting Older… HIV/AIDS Discharges among PLWHA, 50 years of age or older 1994 10% 2003 23% Medicaid Recipients with HIV/AIDS, Age 50+ 1993 6% 2002 18% Source: SPARCS database, NYSDOH Source: Medicaid Claims database

  13. Changing Morbidity

  14. James Cadenhead Infected with HIV for 18 years. Has had Hep B, C, toxoplasmosis. “..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?” New York Times, Aug. 17, 2004

  15. 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

  16. Total cholesterol (per 1-mmol/liter increase) Diabetes Prior cardiovascular disease Tryglicerides (per doubling) Hypertension Male sex Exposure to combination antiretroviral therapy (per additional year) Current or former smoker Age (per additional 5 yr) Myocardial Infarction: Incidence and Risk Factors Among Persons Receiving ART Greenspoon, S. Carr, A. Cardiovascular risk and body-fat abnormalities in HIV-infected adults. N Engl J Med 2005; 352:48–62

  17. The Writing Committee of the D:A:D Study Group. Cardio- and cerebrovascular events in HIV-infected persons. AIDS 2004; 18:1811–1817

  18. Myocardial infarction Holmberg et al. Trends in rates of Myocardial infarction among patients with HIV N Engl J Med 2004; 350:730-731

  19. Acute Myocardial Infarction Source: SPARCS database, NYSDOH

  20. Chronic Bronchitis and Emphysema Source: SPARCS database, NYSDOH

  21. “Cigarette smoking is the most important modifiable cardiovascular risk factor among HIV-infected patients.” “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

  22. HIV and Cancer

  23. Trends in AIDS-Defining and Non–AIDS-Defining Malignancies among HIV-InfectedPatients: 1989–2002 Cases per 1000 pat-years 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

  24. Cancers of the larynx and oropharynx HAART HAART

  25. Cancer of the lung/tracheaper 100,000 HIV/AIDS discharges, 1994-2002 Source: SPARCS

  26. Cancer of the lung/tracheaper 100,000 Medicaid recipients with HIV/AIDS, 1993-2001 Source: Medicaid Claims database

  27. Cancers of the colon, anus, liver & pancreas HAART HAART

  28. Cancer among People with HIVSwitzerland, 1985-2002 Standardized Incidence Ratios (SIRs) 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

  29. Cancer among People with HIVSwitzerland, 1985-2002 • All cancers of lip, mouth and pharynx, trachea, bronchus and lung (8) occurred among smokers 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

  30. How Big is the Problem? • New England clinics: More than 70% of HIV+ smoke • Swiss HIV Cohort Study • 72% are current/former smokers • 96% 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

  31. Low Income HIV+ in NYC • 428 HIV+ Medicaid recipients, NYC • Age: 22-75 59% males 53% African Americans 30% Latinos • HS education or less : 87% • 66% current smokers (mean=16 cig./day) • 19% former smokers • Current smokers • Greater use of illicit substances • Lower state of health • Lower 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

  32. Tobacco Use Survey 2005 Preliminary Results (August 31, 2005) NYS DOH AIDS Institute Office of the Medical Director Office of Program Evaluation and Research

  33. Purpose: To ascertain smoking prevalence among PLHWA in care in New York State. Methodology: • 2 Sampling Strata • Designated AIDS Care Centers • Adult Day Health Centers • Target sample size for each facility/program related to caseload. NYS DOH AIDS Institute, OMD/OPER

  34. Methodology: • 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 NYS DOH AIDS Institute, OMD/OPER

  35. Upstate NY Region Erie County Medical Center* Nassau University* Strong Memorial Hospital* SUNY Syracuse* United Health Services* Westchester County Medical Center* * Designated AIDS Care Center **Adult Day Health Center NYC Region Bronx Lebanon* Harlem United** Housing Works 13th Street** Housing Works 98th Street** NY Hospital of Queens* PROMESA** Saint Vincent Medical Center* SUNY Brooklyn* Village Center** Survey Administered in 15 Facilities/Programs, March 2005 NYS DOH AIDS Institute, OMD/OPER

  36. Area Target Sample Size Number Returned Percent of Target Returned* Upstate 426 399 94% NYC 802 695 87% Total 1228 1094 89% Table 1: Survey Return Rate *Just 41 subjects (3.4%) refused to completed the survey. NYS DOH AIDS Institute, OMD/OPER

  37. Race/Ethnicity (N) % Hispanic 281 26.9 White 158 15.1 African American 560 53.6 Other 46 4.4 Total 1045 100 *Other includes: Albanian (2) American Indian – Alaska Native (19) Asian (3) Australian (1) Canadian (1) French (1) Guyana (1) Haitian (6) Indian (2) Iranian (1) Native Hawaiian or Pacific (9) Table 2: Race/Ethnicity (N=1045) NYS DOH AIDS Institute, OMD/OPER

  38. Use Status N % Currently Use 638 59.2 Used in the Past 264 24.5 Never Used 175 16.3 Total 1077 100 Table 3: Tobacco Use(N=1077) Includes Cigarettes, Cigars, Pipes and Chewing Tobacco* *631 cases in the “Currently Use” category are cigarette smokers. 255 cases in the “Used in the Past” category were cigarette smokers. NYS DOH AIDS Institute, OMD/OPER

  39. Smoking Knowledge Statements % Correct If a person has smoked a pack of cigarettes a day for more than 20 years, there is little benefit to quitting smoking. N=1039 56% Nicotine is a cause of cancer. N=1023 14% The risk of having a heart attack is higher among people who smoke. N=1022 84% The risk of getting lung cancer is higher among people who smoke. N=1017 86% Because it takes many years for the effects of smoking to occur, smoking isn’t a serious health concern for HIV positive people. N=1027 63% Smoking isn’t any more dangerous for HIV positive individuals than it is to people without HIV. N=1027 64% Table 8: Percentage Correct on Smoking Knowledge Statements NYS DOH AIDS Institute, OMD/OPER

  40. N % Yes 372 63.7 No 212 36.3 Total 584 100 During the past 12 months, have you stopped smoking for one day or longer because you were trying to quit? (N=584) P=<.05 NYS DOH AIDS Institute, OMD/OPER

  41. N % Yes 426 74.5 No 146 25.5 Total 572 100 Table 13: Are you currently interested in stopping smoking? (N=572) NYS DOH AIDS Institute, OMD/OPER

  42. Smoking CessationAre PLWHA Interested? • Survey of patients (n=228), San Francisco General Hospital • Smokers=123 (54%) • Smokers interested in quitting = 77 (63%) Mamary EM et al. Cigarette smoking and the desire to quit among individuals living with HIV. AIDS Patient.Care STDS. 2002;16:39-42.

  43. N % Very likely 195 34.7 Somewhat likely 229 40.7 Somewhat unlikely 97 17.3 Very Unlikely 417 7.3 Total 562 100 Table 14: If you decided to give up smoking altogether during the next year, how likely do you think you would be to succeed?(N=562) NYS DOH AIDS Institute, OMD/OPER

  44. How Big is the Problem? • BIG • HIV+ populations include the following overlapping conditions • Substance use • Mental health • Poverty, low educational attainment Niaura R et al. Smoking among HIV-positive persons. Ann Behav Med 1999; 21(Suppl):S116

  45. Smoking------Risk Factor for… • Cardiovascular diseases • Cancers • Lung diseases • GI tract • Age-related disorders • …. • Single most preventable cause of death

  46. HIV Disease: New Paradigm • Lifestyle-related risk factors • Smoking • Physical activity • Healthy diet • Alcohol, recreational drugs • Sexual activity

More Related