Smoking Cessation in People Living With HIV: Results From Italian STOPSHIV Project Cohort

OBJECTIVE: Assessment of real-life effectiveness of an intervention for smoking cessation in people living with HIV (PLWH) in long-term follow-up. SETTING: Multicenter cohort prospective study, involving PLWH from Italian Infectious Disease Centers. METHODS: During routine HIV care, clinicians usually promote smoking cessation implementing the European AIDS Clinical Society guidelines. We analyzed smoking cessation for 9 years of follow-up. The brief counseling intervention was defined "standard" when delivered in at least half follow-up visits, "soft" if less than half. We excluded from the analysis 85 patients lost at follow-up. The main outcome was definitive smoking interruption at the last follow-up visit (smoking abstinence for >6 months and no recurrence). Abstinence predictors were evaluated using a Cox-proportional hazard regression model [adjusted hazard ratio (aHR), and 95% confidence interval (CI)]. RESULTS: Out of 1002 PLWH with prolonged follow-up, 510 were current smokers at baseline (median observation time was 7.4 years, interquartile range 6.9-8.0). The standard intervention was performed in 340 smokers (66.7%) and soft intervention in the remaining 170 (33.3%). At the last visit, 66 (12.9%) PLWH achieved self-reported definitive smoking cessation, 59 (17.4%) in standard and 7 (4.1%) in soft intervention. At the multivariate analysis, Fagerström score (by -1, aHR 1.16, 95% CI: 1.05 to 1.29), stage of change (preparation/action aHR 3.33, 95% CI: 1.81 to 6.12), and standard intervention (aHR 2.45, 95% CI: 1.08 to 5.58) were predictors of smoking cessation. CONCLUSIONS: The brief intervention led to self-reported definite smoking cessation in 12.9% of PLWH. The standard intervention was more effective: thus, adherence to intervention emerged as a critical factor for the effectiveness.