Integration of anti-smoking strategies into TB, HIV programs needed

Anti-smoking campaigns must be integrated with TB, HIV and TB-HIV programs as smoking is a “critical issue” for the treatment and care of the two diseases, according to a study of the Parisbased International Union Against Tuberculosis and Lung Disease.

The study showed that smoking and exposure to second-hand smoke are known to exacerbate TB and HIV.

However, evidence-based strategies to reduce tobacco use are not yet routinely included in treatment programs.

A modifiable risk factor

Dealing with tobacco use, as a modifiable risk factor common to the two diseases, will improve TB and HIV outcomes and care, according to the study published in the International Journal of Tuberculosis and Lung Disease.

“We are failing people with TB and HIV if we treat smoking as a ‘to do later’ issue,” said Angela Jackson-Morris, of the union’s Department of Tobacco Control, and lead author of the study.

“Practitioners and policymakers urgently need to address smoking as part of their care for people with TB and HIV,” she said.

Smoking is more prevalent among people with TB or HIV, Morris said.

“It is associated with TB infection, TB disease, and poorer outcomes for TB treatment,” she said.

“People living with HIV are at greater risk from tobacco-related diseases and smoking may also inhibit the effectiveness of lifesaving antiretroviral therapies. By incorporating a set of practical measures into everyday practice, we can improve the treatment outcomes of men, women and children with TB and HIV,” she added.

Critical links

Current guidance on dealing with smoking among people with TB and HIV does not draw together the critical links between the three issues, the study said.

It proposed expanding the scope of TB-HIV collaboration to include anti-smoking strategies – applying key actions from the World Health Organization’s “MPOWER” package of evidence-based interventions for reducing tobacco use to TB and HIV practice.

The MPOWER package consists of six proven policies against smoking: monitor tobacco use and prevention, protect people from tobacco smoke, offer help to quit tobacco use, warn about the dangers of tobacco, enforce bans on tobacco advertising, promotion and sponsorship, and raise taxes on tobacco.

Collision of the HIV and TB epidemics has been described as a syndemic due to the synergistic impact on the burden of disease, the study said.

Based on limited available data, the observed prevalence of smoking among TB patients has doubled or is only slightly greater than the prevalence in the general population.

Smokers with HIV suffer disproportionally from non- communicable diseases compared to non-smoking infected individuals.

Smokers with HIV have an increased risk of developing lung and other forms of cancer, bacterial pneumonia, chronic obstructive pulmonary disease and heart disease. They have a greater rate of progression from HIV infection to AIDS and have a poorer response to life-saving anti-retroviral treatment, the study said.

Simple interventions

save lives

Smoking with HIV and TB creates a perfect storm that dramatically increases a patient’s risk for TB and for poorer outcomes and death from these two diseases, according to co-author Eric Pevzner, team leader for vulnerable populations in the TB prevention and control branch of the Centers for Disease Control and Prevention.

“Treating TB and HIV provides an ideal opportunity to offer the support and advice proven to help patients quit tobacco and realize the benefits of life-saving treatments for TB and HIV,” he said.

MPOWER interventions work so “we must act quickly to integrate these simple interventions that save time, money and, most importantly, lives,” he added.

TB and HIV are responsible for the greatest number of deaths worldwide from communicable disease, and tobacco use is the leading cause of death, the study said.