Department of Medicine and Department of Epidemiology and Population Health, Division of Infectious Diseases, Albert Einstein College of Medicine, Bronx, NY, USA.
Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, USA; Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston, MA, USA; Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
Lancet HIV. 2021 Oct;8(10):e652-e658. doi: 10.1016/S2352-3018(21)00156-9. Epub 2021 Aug 27.
Tobacco use is now a leading cause of death in people living with HIV in the USA. Increasing cessation rates in this group is a public health priority, yet the results of clinical trials aimed at optimising tobacco treatment strategies have been largely disappointing. Combinations of behavioural and pharmacological cessation therapies in people living with HIV have yielded increases in short-term quit rates, but few have shown long-term efficacy. Even with aggressive therapy combining intensive behavioural treatment with pharmacological agents, most smokers living with HIV continue to smoke. The generalised approach to tobacco treatment that prevails in guidelines and in clinical practices might do a disservice to these individuals, who represent a sizable segment of the population of people living with HIV. Harm reduction is a sensible and needed approach for smokers living with HIV who are unable or unwilling to quit. In this Viewpoint, we take an expansive view of harm reduction to include not only cutting down on cigarette intake for persistent smokers, but also reducing smoking's downstream health effects by increasing lung cancer screening and by controlling concurrent cardiovascular risk factors, especially hypertension and hyperlipidaemia.
在美国，吸烟是 HIV 感染者的主要死因之一。提高该人群的戒烟率是公共卫生的重点，但旨在优化烟草治疗策略的临床试验结果却令人大失所望。在 HIV 感染者中结合行为和药物戒烟治疗可提高短期戒烟率，但很少有长期疗效。即使采用强化行为治疗与药物联合的积极治疗，大多数 HIV 感染者仍继续吸烟。在指南和临床实践中普遍采用的针对烟草的治疗方法可能对这些人不利，他们是 HIV 感染者群体中相当大的一部分。对于无法或不愿戒烟的 HIV 感染者，减少危害是一种合理且必要的方法。在本观点中，我们对减少危害进行了广泛的探讨，不仅包括减少持续吸烟者的香烟摄入量，还包括通过增加肺癌筛查和控制同时存在的心血管危险因素（尤其是高血压和高脂血症）来减少吸烟的下游健康影响。
