Benard Antoine, Bonnet Fabrice, Tessier Jean-François, Fossoux Helene, Dupon Michel, Mercie Patrick, Ragnaud Jean-Marie, Viallard Jean-François, Dabis François, Chene Genevieve
INSERM, U593, Université Victor Segalen Bordeaux 2, ISPED, F-33076 Bordeaux, France.
AIDS Patient Care STDS. 2007 Jul;21(7):458-68. doi: 10.1089/apc.2006.0142.
In treated HIV-infected patients, mortality is now dominated by non-AIDS-related causes in which tobacco smoking is a predominant risk factor. The implementation of tobacco smoking cessation programs is therefore warranted to increase survival but should consider the specificities of this population to be successful. All outpatients consulting in May to June 2004 within the ANRS CO3 Aquitaine Cohort of HIV-infected patients were asked to complete a self-administered questionnaire including questions about tobacco and other drugs consumption, the Fagerström Test for Nicotine Dependence (FTND), a visual scale to estimate motivation to stop smoking and the Center for Epidemiologic Studies Depression (CESD) scale. Among 509 patients included, mean age was 44 years, 74% were men, 19% were infected through injection drug use, and 257 (51%) were regular smokers (at least one cigarette per day). Among them, 60% had a medium or strong nicotine dependence (FTND = 5), 40% were motivated to quit smoking and 70% had already tried at least once. An FTND of 5 or more was more frequently reported in the 146 smokers (62%) with depressive symptoms compared to other smokers (70% versus 48%). Fifty-five regular smokers (23%) were codependent on cannabis and 31 (12%) to alcohol. Overall, only 35 (14%) regular smokers were motivated, non-codependent, without depressive symptoms, and could be proposed a standard tobacco cessation program. Depressive symptoms were highly prevalent in this representative population of HIV-infected patients. To be successful, smoking cessation interventions should be specifically built to take into account depression and codependencies in addition to nicotine dependence and motivation.
在接受治疗的HIV感染患者中，目前死亡率主要由非艾滋病相关原因主导，其中吸烟是主要危险因素。因此，实施戒烟计划对于提高生存率是必要的，但要取得成功应考虑该人群的特殊性。我们要求2004年5月至6月在ANRS CO3阿基坦HIV感染患者队列中就诊的所有门诊患者填写一份自我管理问卷，包括有关烟草和其他药物使用情况的问题、尼古丁依赖的法格斯特罗姆测试（FTND）、评估戒烟动机的视觉量表以及流行病学研究中心抑郁量表（CESD）。在纳入的509例患者中，平均年龄为44岁，74%为男性，19%通过注射吸毒感染，257例（51%）为经常吸烟者（每天至少吸一支烟）。其中，60%有中度或重度尼古丁依赖（FTND = 5），40%有戒烟动机，70%至少尝试过一次戒烟。与其他吸烟者相比，146例有抑郁症状的吸烟者（62%）更频繁地报告FTND为5或更高（70%对48%）。55例经常吸烟者（23%）同时依赖大麻，31例（12%）同时依赖酒精。总体而言，只有35例（14%）经常吸烟者有戒烟动机、无共病、无抑郁症状，可以接受标准的戒烟计划。抑郁症状在这一具有代表性的HIV感染患者人群中非常普遍。要取得成功，戒烟干预措施除了考虑尼古丁依赖和动机外，还应特别针对抑郁和共病情况制定。
