HIV-related symptoms significantly reduced three weeks after quitting smoking

Quitting smoking results in a significantly reduced HIV-related symptom burden after an average of three weeks, according to a study published in the September 2007 edition of the journal, AIDS Patient Care and STDs. The authors conclude that, “along with the decreased risk of numerous adverse health outcomes associated with smoking, cessation may represent an effective way to reduce the daily impact of HIV disease and treatment side-effects.”

Smoking and HIV disease

Although previous studies have found that cigarette smoking appears to decrease the effectiveness of anti-HIV therapy, and increase the mortality rate, and public health interventions strongly support the efforts of HIV-positive individuals to quit smoking, few studies have reported on the benefits in terms of symptoms and other quality of life measures of smoking cessation interventions.

Consequently, investigators from Houston, Texas conducted a randomised trial of a smoking cessation intervention, the secondary endpoint of which evaluated the effects of quitting smoking on both HIV-related symptoms and health-related quality of life (HRQOL).

A total of 95 cigarette smokers attending an inner city HIV clinic were enrolled into the smoking cessation study and randomised to two arms. Both arms received the standard care of an initial doctor’s consultation, nicotine patches and written self-help materials, with one arm receiving additional smoking cessation counselling via mobile phone as well as access to a telephone hotline. Of the original 95, 77 (81%) completed three months of follow-up, and these 77 comprised the study sample.

The average age of study participants was 43.5 years; three-quarters were African American; and one in five were women. Just over one third were exposed to HIV via sex between men; another third were exposed to HIV via sex between men and women; and one in five were exposed to HIV via injecting drugs.

Standard versus mobile phone and hotline intervention

The study assessed smoking abstinence in two ways. Point prevalence abstinence was defined as a self-report of not having had even one puff of a cigarette in the previous 24 hours. This was verified via measuring levels of carbon monoxide in the breath: below seven parts per million were considered to be abstinent. Length of smoking abstinence was based on self-report, and was defined as the longest period of time that a study participant was able to go without smoking during the study.

At three months, point prevalent abstinence was 23.4% with the average period of abstinence being 21 days for the cohort as a whole. The mobile phone intervention group were significantly more likely to achieve point prevalent abstinence (36.6% vs. 10.3%; p = 0.006) and a longer period of abstinence (31 days vs. 12 days; p = 0.003) than the standard care group.

When the investigators analysed the social and demographic factors – age, ethnic group, gender, education, living with partner, HIV exposure group – affecting symptom burden and HRQOL they found that only HIV exposure group was significantly associated with these outcomes: those participants who had acquired HIV via injecting drug use had poorer mental health scores (p = 0.007) and greater symptom burden (p = 0.05) compared to participants who acquired HIV in other ways.

Symptom burden significantly lower three weeks after quitting smoking

The most striking finding of the investigator’s multivariate analysis was that a longer length of smoking abstinence was significantly associated with a reduced symptom burden after three months of follow-up (p = 0.02). As noted above, the average abstinence period was just three weeks.

However, no significant associations were seen with point prevalent abstinence (i.e. after a minimum of 24 hours not smoking). They point to a recent study (Erickson), which found that most participants experienced a decline in HRQOL one week after quitting “This indicates”, write the investigators, “that the benefits of cessation, in terms of reduced HIV-related symptom burden, may take some time to be realised.”

In addition, the investigators found no significant association between physical and mental health scores and either point prevalent or length of abstinence. They suggest that this may be due to symptoms of nicotine withdrawal, many of which are similar to HIV-related symptoms (e.g. fatigue, cough, headache, insomnia, and gastrointestinal discomfort). This “may have also complicated our ability to assess the effects of relatively short-term cessation and the symptom burden and HRQOL variables under investigation,” they write.

Limitations and conclusions

The investigators note that the study was limited by a single three-month follow-up period and the relatively small sample size. “By limiting our scope of HRQOL outcome [to physical and mental health summary scores] we may have missed other important effects of smoking cessation,” they write. “Similarly, we considered only an overall symptom burden index rather than individual symptoms.”

They note that a larger trial of the mobile phone intervention study is now underway and that this may overcome many of the current study’s limitations.

They conclude by noting that their study indicates that “length of time of smoking cessation is associated with a reduction in HIV-related symptom burden” and that “along with the decreased risk of numerous adverse health outcomes associated with smoking, cessation may represent an effective way to reduce the daily impact of HIV disease and treatment side-effects.”