Up in Smoke
A new study has found smoking may blunt our response to HIV drugs.
Jeff Williams investigates
Illustration: C(Aitch)
The
risks of cigarettes have been well known to smokers and non-smokers alike
for over a generation. Smoking is bad for our health and can lead to debilitating
and often fatal illnesses. This has not stopped people smoking, but the number
of smokers has almost halved over the last 30 years.
When it didn’t matter
Many HIV positive people smoke despite their diagnosis. In the bad old days
before combination therapy, when a diagnosis was an almost certain death sentence,
it didn’t matter if people with HIV smoked as we did not live long enough
to die of lung cancer. But with the advent of effective treatments, life expectancy
in the developed world is now such that we need to be aware of the same health
risks as our negative brethren.
When sufficiently irritated by people smoking around me to comment on how
much better they (and I) would feel if they stopped, my words are mostly met
with resignation; ‘I need my nicotine’; ‘All my friends
do it’; or ‘My doctor smokes, so what can be wrong with it?’
Remarks unlikely to make for coherent discussion.
Hard evidence and hard work
But now we have evidence that smoking may undermine the benefits of HIV medication.
A study published in the American Journal of Public Health in July was the
first to uncover a clear link between smoking and HIV progression. Researchers
found smokers were more likely to be diagnosed with an Aids-defining illness
or to die. In other words, smoking undermines the beneficial effects of HIV
treatment and the hard work we put into adhering to our meds.
A previous study had found no link between smoking, HIV progression and/or
death. But this was published in 1997, just as anti-HIV drugs became available,
and so represented an incomplete investigation.
Smoke and CD4s
In the latest study, researchers analysed data from an investigation into
the progression of HIV in 2,000 women on HAART across the US over five years.
More than half were active smokers. They found average CD4 counts were higher
among smokers, but over time, smokers’ counts fell below those of non-smokers.
Smokers also had a 36 per cent increased risk of developing an Aids-defining
illness and a 53 per cent increased risk of dying after adjusting for pre-existing
factors such as age and CD4 count at the start of the study period.
A
higher risk of Aids
Smokers were more likely to be poorer, to have used drugs and to have hep
C. Adherence to HIV drugs was also significantly lower among smokers. This
meant researchers had to be careful about how they analysed the data. Despite
these differences there were still statistically significant differences between
smokers and non-smokers. The researchers said: “This clearly demonstrated
that HIV positive women who smoke have a higher risk of acquiring an Aids-defining
illnesses or dying.” They also said anti-HIV medication was “not
as beneficial as it is in non-smokers”.
Firm conclusions
Although the recent study demonstrates a clear link between smoking and disease
progression, the researchers point out it is impossible to control and isolate
all aspects of individuals in such a large and long-term study. They couldn’t,
for example, exclude potential bias among patients in poor health who may
be more or less likely to smoke. Thus a patient in poor health may feel she
has nothing to lose and choose to smoke anyway, despite the health risks.
Nevertheless, the researchers were confident enough to conclude: “The
data suggest the treatment of HIV positive women with potent antiretroviral
therapy may be less effective in those who smoke cigarettes and point to a
need to promote smoking cessation.” Larger, better characterised studies
may yet yield firmer conclusions and send a clearer message to those living
with HIV who continue to smoke.
Will power/cold turkey
No side effects and no cost, but most people fail using this method alone.
No-one expects alcoholics to stop drinking without support so stop being a
hard-nut and get some help. 4/10 - fine, if you’re that kind of person
Cut
down and quit
Gradually reducing the number you smoke over a period sounds sensible, but
many who try become increasingly stressed as the days go by, building to a
crescendo of panic as one finally becomes zero. You find yourself back at
square one but less motivated to try again. 3/10 - may be setting yourself
up for failure
Nicotine replacement therapy (NRT)
Patches, gum, inhalers and lozenges all supply a gradually diminishing amount
of nicotine to help you over the initial ‘withdrawal’ period.
NRT helps remove the anxiety associated with stopping. Available over the
counter and more effective if you follow the prescribed course. 6/10 - make
it easy on yourself
Support groups and cessation courses
Many help-lines offer advice and support (see below) but sharing experiences
with others can bolster your resolve. Research shows you are four times more
likely to succeed this way. Different courses use various techniques so find
out what is involved in advance. Widely available free of charge so be wary
of private clinics making extravagant claims. 8/10 - asking for help is a
sign of strength
Acupuncture
Acupuncture to treat smoking has been used since it was shown to alleviate
heroin withdrawal symptoms in addicts. Needles are inserted into points in
the ear and sometimes a pressure plaster is left in place for a time. See
page 48 for more on acupuncture. 4/10 - if it works for you, it works for
you
Zyban
This prescription drug desensitises the brain’s nicotine receptors,
reducing the urge to smoke. However smoking is both physically and psychologically
addictive. Zyban may reduce the nicotine craving but it does not eliminate
the voice in your head saying you need a fag to de-stress. Also can have nasty
side-effects (fits, insomnia, headache) and interacts with HIV meds so talk
to your HIV specialist first. 2/10 - no magic bullet
Hypnotherapy
After an initial consultation to work out the reasons behind your addiction,
a hynotherapist will put you into a hypnotic state and use suggestion to address
the route causes. It is painless and has no side effects. Research published
in New Scientist said it was the most effective method. However, it can be
expensive - up to £100 per session - and it does not work for all. 6/10
- spooky, but may be worth a go
Self-help books
Many books claim to help you stop, the most popular being Allan Carr’s
Easy Way to Stop Smoking. Controversially, it claims nicotine withdrawal is
barely noticeable and tackles smokers’ fear of abandoning their ‘pleasure
crutch’ by pointing out that it isn’t really pleasurable. Sounds
radical, but has worked for thousands including Richard Branson, Ruby Wax
and this writer (two years, no pangs, no lapses). 8/10 - you’ve got
nothing to lose
Getting help
NHS: helpline, clinics and trained advisers. www.givingupsmoking.co.uk 0800
169 0169
QUIT: independent charity helping smokers to stop. www.quit.org.uk
0800 00 22 00
HIV organisations that run courses:
Body Positive North-West: 0161 873 8100
GMFA: 020 7738 3712
Positive East: 020 7791 2855
Shield: 0114 278 7916
Waverley Care: 0131 661 0982
Therapists
• www.thehypnotherapyassociation.co.uk
01257 262124
• www.medical-acupuncture.co.uk
01606 786782
