Natcher Conference Center, NIH
October 9, 2007
Allison Chausmer (NIDA); Diane Lawrence (NIDA); Cathy Backinger (NCI); Gerald Sharp (NIAID); Xingzhu Liu (FIC); Francisco Sy (NCMHD)
Meeting Purpose and Intent:
The purpose of this workshop was to highlight understudied issues related to cigarette smoking in HIV-infected persons. In the U.S., the prevalence of cigarette smoking is estimated to be 50-70% among HIV-infected persons and 75% among substance abusers, compared to 25% in the general population. Smoking is associated with reduced health-related quality of life in HIV-infected persons, increased incidence of bacterial pneumonia and other AIDS defining illnesses, increase incidence of malignancies, and increased mortality risk compared to HIV+ non-smokers. Indeed, emerging evidence suggests that tobacco smoking may actually be an independent risk factor for HIV infection. Some studies also suggest that nicotine smoking may be associated with faster progression to AIDS and/or neurological complications of AIDS. Furthermore, smokers taking Highly Active Antiretroviral Therapy (HAART) are at increased risk for lipodystrophy and cardiac disease compared to non-smokers. New data also suggests that women smokers on HAART have poorer viral responses, poorer immunologic response, greater risk of virologic rebound, more frequent immunologic failure, and have higher risk of developing AIDS.
This workshop featured 13 presentations followed by breakout groups discussing opportunities for accelerating scientific breakthroughs and a list of priority research areas.
Presentations and Workshop Activities:
- Dr. Damon Vidrine: Cigarette smoking among persons living with HIV/AIDS: A growing public health problem
- Dr. R. Bryan Rock: Nicotine and HIV-associated dementia
- Dr. Kristina Crothers: Impact of cigarette smoking on respiratory-related illness and outcomes in patients with HIV infection
- Dr. Mohan L. Sopori: Nicotine receptors in inflammation, infection, and immunity
- Dr. Maria Jose Miguez: HAART benefits hurt by smoking
- Dr. James Sosman: Smoking and antiretroviral therapy on cardiovascular risk for people with HIV
- Dr. David Feldman: CYP1A1 genotype modifies the impact of smoking on effectiveness of HAART
- Drs. Arunabh Talwar and Virginia Reichert: Pharmacotherapeutic implications of tobacco use and HIV: The nuts and bolds of successful treatment for smokers
- Dr. Nancy Reynolds: Smoking and illness representations of persons living with HIV: A promising link for intervention
- Dr. Ray Niaura: A motivational intervention for smoking cessation among HIV+ smokers
- Dr. Jon Samet: The global tobacco epidemic: How can we understand implications for HIV/AIDS
- Dr. Vendham Gajalakshmi: Smoking, tuberculosis, and HIV/AIDS in South India
- Dr. M. Mussi-Pinhata: Correlates of neonatal infectious disease morbidity in HIV-uninfected infants born to HIV-infected Latin American and Caribbean mothers
The presenters and invited attendees participated in afternoon breakout groups on "Disease Mechanisms", "Treatment" or "Epidemiology/Population". Each group discussed where the largest gaps were, and what the top research priorities should be.
Questions that were addressed included:
- To the extent that data are available, what is the scope of the problem?
- What are gap areas, including data from diverse age groups, gender groups, regionally distinct groups, and child-bearing women?
- How can we better assess regional and tribal variation in use?
- What infrastructures exist that might be resources for data collection?
- How should research proceed?
- How can data be collected to ensure a link to services for prevention and treatment?
A special, peer-reviewed supplement of AIDS Education and Prevention: An Interdisciplinary Journal is anticipated to be published in March/April 2008. Submissions will be by invitation only and will be based on several areas of interest that follow directly from this workshop, including:
- Biological and behavioral foundation of the relationship between tobacco smoking and HIV/AIDS
- Interactions between smoking, HIV/AIDS and other diseases or infections
- Interactions between smoking and HAART
- Smoking cessation strategies for smokers with HIV/AIDS
- Global implications of tobacco use and HIV/AIDS
This supplement will continue the partnership between NIDA, NCI, FIC, NCMHD and NIAID.