Harm reduction for smokers living with HIV.

Autor:	Shuter J; Department of Medicine and Department of Epidemiology and Population Health, Division of Infectious Diseases, Albert Einstein College of Medicine, Bronx, NY, USA. Electronic address: jonathan.shuter@einsteinmed.org., Reddy KP; 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., Hyle EP; Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, USA; Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA., Stanton CA; Behavioral Health and Health Policy Practice, Westat, Rockville, MD, USA; Department of Oncology, Georgetown University Medical Center, Washington, DC, USA., Rigotti NA; Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston, MA, USA; Mongan Institute for Health Policy, Massachusetts General Hospital, Boston, MA, USA; Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
Jazyk:	angličtina
Zdroj:	The lancet. HIV [Lancet HIV] 2021 Oct; Vol. 8 (10), pp. e652-e658. Date of Electronic Publication: 2021 Aug 27.
DOI:	10.1016/S2352-3018(21)00156-9
Abstrakt:	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. Competing Interests: Declaration of interests NAR has served as a consultant to Achieve Life Sciences regarding an investigational smoking cessation medication (cytisinicline). She is the principal investigator of a multicentre trial of the medication that is sponsored by Achieve Life Sciences, and her institution, the Massachusetts General Hospital (Boston, MA, USA), receives research funding to serve as a site for the trial. NAR also receives royalties from UpToDate for authoring the section on smoking cessation. All other authors declare no competing interests. (Copyright © 2021 Elsevier Ltd. All rights reserved.)
Databáze:	MEDLINE
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