A perfect storm: HIV, tuberculosis and smoking

Research released on the final day of the conference highlighted the interrelation between tobacco-related diseases and communicable diseases such as HIV and tuberculosis (TB).

“It is both timely and highly appropriate that research on the growing impact of smoking and infectious diseases such as HIV and tuberculosis is being released at the WCTOH in South Africa where infection rates of both diseases are amongst the highest in the world,” said Professor Lekan Ayo-Yusuf, Chair of the WCTOH Scientific Committee. “These emerging studies will be vital tools moving forward in achieving good health and promoting well-being for all, in the context of the Sustainable Development Goals.”

At the press conference where this data was released, Mark Parascandola, National Cancer Institute, spoke about a 25 country analysis of smoking and HIV in sub-Saharan Africa. This study explored the association between cigarette smoking and HIV status, and the relationship between smokeless tobacco use and HIV status.

He said, “Around the world smoking is associated with lower income and lower education settings, people who smoke are more likely to engage in high risk and poor health behaviours.”

He went on to say that in high-income countries, being HIV positive is associated with higher rates of smoking. This is important for public health because evidence suggests that HIV/AIDS patients who smoke have poorer treatment outcomes and survival outcomes. Moreover, both smoking and HIV are risk factors for comorbidities such as TB, which is highly prevalent in some low-and middle-income countries. This research explores the understudied HIV-smoking relationship in sub-Saharan Africa, where tobacco use patterns and HIV prevalence differ greatly from other world regions.

Lin Yan of the International Union Against Tuberculosis and Lung Disease (The Union), China Office in Beijing spoke about evidence suggesting a significant link between smoking and TB. He said that smokers tend to delay accessing health services; and that they are more likely to have poor treatment outcomes, and a higher risk of recurrent TB than non-smokers. To address the dual burden of TB and smoking, The Union published guidelines on smoking cessation intervention for TB patients, and piloted it in China. By the end of anti-TB treatment, two thirds of current smokers stopped smoking, though the long-term outcome is unknown.