Department of Psychiatry, Massachusetts General Hospital, Boston, MA.
Harvard Medical School, Boston, MA.
J Acquir Immune Defic Syndr. 2018 Oct 1;79(2):261-268. doi: 10.1097/QAI.0000000000001787.
Among people living with HIV, cigarette smoking rates are higher than among the general population, and anxiety, depression, and their disorders are common and associated with smoking and poorer outcomes during cessation. This study evaluated the efficacy of an integrated smoking cessation intervention, developed to target anxiety, depression, and smoking cessation concurrently among people living with HIV.
Smokers living with HIV who reported at least moderate motivation to quit smoking were randomized into a novel 9-week integrated intervention (QUIT), consisting of 1 psychoeducation (prerandomization) session and 9 weekly 1-hour sessions of cognitive behavioral therapy for smoking cessation and anxiety/depression plus nicotine replacement therapy, or a 9-week enhanced standard smoking intervention (ETAU), consisting of 1 psychoeducation session (prerandomization) and 4 brief weekly check-in sessions plus nicotine replacement therapy. All were instructed to make a quit attempt at week 6.
Seventy-two participants were enrolled, and 53 were randomized. 41/53 participants completed the active treatment phase of the study. 7-day point-prevalence abstinence, verified with expired carbon monoxide, was significantly higher among those in the integrated intervention than those in the enhanced standard intervention both end-of-treatment {[MQUIT = 59%, METAU = 9%; b = 5.60, 95% confidence interval: (2.64 to 8.56), t(332) = 3.72, P < 0.001]} and 6-months post-quit date {[MQUIT = 46%, METAU = 5%; b = 7.69, 95% confidence interval: (4.60 to 10.78), t(332) = 4.90, P < 0.001]}. Consideration of patterns of missingness did not alter the significance of these findings.
The integrated intervention was associated with substantially higher short-term and long-term abstinence rates than the enhanced standard intervention. These data provide promising initial evidence supporting the benefits of an integrated anxiety-depression/smoking cessation program specifically tailored for people living with HIV.
在艾滋病毒感染者中，吸烟率高于一般人群，焦虑、抑郁及其障碍较为常见，并与吸烟和戒烟期间的较差结果相关。本研究评估了一种综合戒烟干预措施的疗效，该措施旨在同时针对艾滋病毒感染者的焦虑、抑郁和戒烟。
报告至少有中度戒烟动机的艾滋病毒感染者被随机分配到一种新的 9 周综合干预措施（QUIT）中，该干预措施包括 1 次心理教育（随机前）和 9 次每周 1 小时的认知行为疗法戒烟和焦虑/抑郁加上尼古丁替代疗法，或 9 周强化标准戒烟干预措施（ETAU），包括 1 次心理教育（随机前）和 4 次简短的每周检查加上尼古丁替代疗法。所有人都被指示在第 6 周尝试戒烟。
共纳入 72 名参与者，其中 53 名被随机分组。53 名参与者中有 41 名完成了研究的主动治疗阶段。用呼出的一氧化碳验证的 7 天点患病率戒断率，在综合干预组中明显高于强化标准干预组，治疗结束时[MQUIT = 59%，METAU = 9%；b = 5.60，95%置信区间：（2.64 至 8.56），t（332）= 3.72，P < 0.001]和戒烟后 6 个月[MQUIT = 46%，METAU = 5%；b = 7.69，95%置信区间：（4.60 至 10.78），t（332）= 4.90，P < 0.001]。考虑缺失模式并没有改变这些发现的意义。
综合干预与强化标准干预相比，短期和长期戒断率显著提高。这些数据为针对艾滋病毒感染者专门设计的综合焦虑抑郁/戒烟计划的益处提供了有希望的初步证据。
