Johns Hopkins School of Medicine, Center for TB Research, Baltimore, Maryland, USA.
The Schroeder Institute for Tobacco Research and Polity Studies at Truth Initiative, Washington, D.C., USA.
Nicotine Tob Res. 2018 Aug 14;20(9):1124-1131. doi: 10.1093/ntr/ntx145.
Smoking likely exacerbates comorbidities which people living with HIV (PLWH) are predisposed. We assessed prevalence and correlates of smoking among PLWH in South Africa, which has 7 million PLWH but inadequate reporting of smoking.
A cross-sectional survey was conducted among randomly selected adults with HIV infection in Klerksdorp, South Africa. Current smoking was assessed by questionnaire, exhaled carbon monoxide (eCO), and urine cotinine.
Of 1210 enrolled adults, 753 (62%) were women. In total, 409 (34%) self-reported ever smoking: 301 (74%) were current and 108 (26%) were former smokers. Using eCO and urine cotinine tests, 239 (52%) men and 100 (13%) women were defined as current smokers. Nearly all smokers (99%) were receiving ART, and had a median (IQR) CD4 count of 333 cells/μL (181-534), viral load of 31 IU/mL (25-4750), and BMI of 21 kg/m2 (19-24). Adjusted analysis among men showed higher odds of smoking with marijuana use (OR = 7.5, 95% CI = 4.1 to 14.6). Among women, 304 (43%) reported using snuff, compared to only 11 (3%) of men, and snuff use was inversely associated with smoking (OR = 0.1; 95% CI = 0.05 to 0.2). A subset of participants (n = 336) was asked about alcohol use, which was positively associated with smoking for men (OR = 8.1, 95% CI = 2.8 to 25.9) and women (OR = 8.5, 95% CI = 2.9 to 26.8).
Smoking prevalence among PLWH in South Africa is alarmingly high. Prevention and cessation strategies that consider marijuana and alcohol use are needed.
As long-term HIV care continues to improve, more people living with HIV (PLWH) will die of diseases, including tuberculosis, for which smoking plays an important causal role. The prevalence of smoking is markedly higher among PLWH in high-resource settings, but data for Africa and other low-resource settings that shoulder the brunt of the HIV epidemic has previously not been well documented. We report an alarmingly high prevalence of smoking among PLWH in South Africa, particularly among men, and a strong association between current smoking and use of other substances.
吸烟可能会使艾滋病毒感染者（PLWH）更容易患上合并症。我们评估了南非 PLWH 吸烟的流行率和相关因素，南非有 700 万 PLWH，但吸烟报告不足。
在南非克勒克斯多普随机选择感染 HIV 的成年人进行横断面调查。通过问卷、呼出的一氧化碳（eCO）和尿液可替宁评估当前吸烟情况。
在 1210 名入组的成年人中，有 753 名（62%）为女性。共有 409 人（34%）自我报告曾吸烟：301 人（74%）为当前吸烟者，108 人（26%）为曾经吸烟者。使用 eCO 和尿液可替宁检测，239 名男性（52%）和 100 名女性（13%）被定义为当前吸烟者。几乎所有的吸烟者（99%）都在接受抗逆转录病毒治疗（ART），中位（IQR）CD4 计数为 333 个细胞/μL（181-534），病毒载量为 31 IU/mL（25-4750），体重指数为 21 kg/m2（19-24）。对男性的调整分析显示，大麻使用与吸烟的几率更高相关（OR=7.5，95%CI=4.1 至 14.6）。在女性中，304 人（43%）报告使用鼻烟，而只有 11 人（3%）的男性使用，鼻烟的使用与吸烟呈反比（OR=0.1；95%CI=0.05 至 0.2）。一小部分参与者（n=336）被问及饮酒情况，饮酒与男性（OR=8.1，95%CI=2.8 至 25.9）和女性（OR=8.5，95%CI=2.9 至 26.8）吸烟呈正相关。
南非 PLWH 的吸烟流行率令人震惊地高。需要制定预防和戒烟策略，同时考虑到大麻和酒精的使用。
随着长期的 HIV 护理继续改善，将有更多的艾滋病毒感染者（PLWH）死于包括结核病在内的疾病，而吸烟在其中起着重要的因果作用。在资源丰富的环境中，PLWH 的吸烟率明显更高，但以前没有很好地记录非洲和其他资源匮乏地区的情况，这些地区承受着艾滋病毒流行的主要负担。我们报告了南非 PLWH 中令人震惊的高吸烟率，尤其是男性，以及当前吸烟与其他物质使用之间的强烈关联。
