The impact of tobacco smoking and smoking cessation on lung cancer and stroke incidence among people with HIV on antiretroviral therapy in South Africa: a simulation modeling study.

Autor:	D'Couto H; Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, USA.; Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston, MA, USA.; Division of Pulmonary, Critical Care, and Sleep Medicine, Medstar Georgetown University Hospital, Washington, DC, USA., Thielking AM; Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, USA., Sewpaul R; Public Health, Societies and Belonging, Human Sciences Research Council, Cape Town, Western Cape, South Africa., Levy DE; Harvard Medical School, Boston, MA, USA.; Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston, MA, USA.; Mongan Institute Health Policy Research Center, Massachusetts General Hospital, Boston, MA, USA., Rigotti NA; Harvard Medical School, Boston, MA, USA.; Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston, MA, USA.; Mongan Institute Health Policy Research Center, Massachusetts General Hospital, Boston, MA, USA.; Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA., Chrysanthopoulou SA; Department of Biostatistics, Brown University School of Public Health, Providence, RI, USA., Siedner MJ; Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, USA.; Harvard Medical School, Boston, MA, USA.; Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA.; Africa Health Research Institute, Somkhele, KwaZulu-Natal, South Africa., Freedberg KA; Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, USA.; Harvard Medical School, Boston, MA, USA.; Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA.; Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA.; Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, Boston, MA, USA., Wood R; Desmond Tutu Health Foundation, Mowbray, Cape Town, Western Cape, South Africa.; Department of Medicine, University of Cape Town, Cape Town, Western Cape, South Africa., Hyle EP; Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, USA.; Harvard Medical School, Boston, MA, USA.; Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA., Reddy KP; Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, USA kpreddy@mgh.harvard.edu.; Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston, MA, USA.; Harvard Medical School, Boston, MA, USA.; Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston, MA, USA.
Jazyk:	angličtina
Zdroj:	BMJ global health [BMJ Glob Health] 2024 Dec 15; Vol. 9 (12). Date of Electronic Publication: 2024 Dec 15.
DOI:	10.1136/bmjgh-2024-017049
Abstrakt:	Introduction: With declining HIV-related mortality, over 20% of people with HIV (PWH) in South Africa are now over age 50 years, and tobacco-related non-communicable disease burden is increasing. We quantified the impact of smoking and smoking cessation on lung cancer and stroke incidence among PWH in South Africa. Methods: Using a microsimulation model, we simulated 18 cohorts of initially virologically suppressed PWH over their lifetime, categorised by sex, initial age (35 years/45 years/55 years) and smoking status (current/former/never). Smoking status remains constant throughout the simulation; individuals with former smoking status quit at model start. PWH can disengage from HIV care and experience virological rebound. We modelled the relative risk of lung cancer for females (males) with current versus never smoking status as 16.69 (15.83), and for females (males) with former versus never smoking status as 1.99-8.80 (1.90-6.18), depending on age at cessation. Corresponding modelled relative risks of stroke were 1.79 (1.54) for current versus never smoking, and 1.00-1.29 (1.00-1.12) for former versus never smoking. We varied HIV-related and smoking-related parameters in sensitivity analyses. Results: Modelled female (male) PWH who stop smoking at age 45 years experience 61.3% (70.9%) and 35.6% (18.6%) lower cumulative lung cancer and stroke incidence over 25 years compared with people who continue smoking. The proportion alive and lung cancer-free or alive and stroke-free over 25 years would increase by 10.4 (9.5) or 10.5 (8.5) percentage points. In sensitivity analysis, smoking and smoking cessation have a greater impact on lung cancer and stroke cumulative incidence if competing HIV-related mortality risks are lower or if PWH experience higher lung cancer and stroke risk compared with people without HIV apart from smoking. Conclusion: Smoking cessation could substantially reduce lung cancer and stroke risk among PWH in South Africa. To reduce the rising non-communicable disease burden among PWH, smoking cessation should become part of routine care of PWH. Competing Interests: Competing interests: KR reports royalties from UpToDate, for authorship of an article about electronic cigarettes. NAR reports a grant to her institution and consulting fees from Achieve Life Sciences, membership in a data and safety monitoring board for Achieve Life Sciences, and royalties from UpToDate, for authorship of articles about tobacco cessation. (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
Databáze:	MEDLINE
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