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Kicking the Habit: HIV and Smoking

for Veterans and the Public

Kicking the Habit: HIV and Smoking

Smoking cigarettes is the leading cause of preventable death in the United States. And smoking is even worse for people with HIV than it is for people without HIV. Among persons living with HIV/AIDS (PLWHA), smoking is closely linked with heart disease and serious lung diseases such as chronic obstructive pulmonary disease (COPD), emphysema, chronic bronchitis, and asthma. It also is associated with a number of types of cancer.

Quitting smoking is a powerful way you can improve your health.

Here are some tools to help you quit.

Nicotine replacement therapies

The most common way people try to quit smoking is by gradually decreasing the body's dependence on and cravings for nicotine. Nicotine replacement therapies can help. These therapies are meant to replace cigarettes. They work by delivering a specific dose of nicotine to your body. When it is time, you switch to a lower dose of nicotine. Over time, the dose of nicotine gets lower and lower. Nicotine replacement therapies come in many different forms, including patches, gum, lozenges, nasal inhalers, and false cigarettes.

Nicotine patches are the most commonly used. Patches typically come in 3 different strengths, sometimes referred to as "steps." Choosing the right step at which to start depends on how much you smoke. How much you smoke also influences how long you'll need to wear the patches. It usually takes about 3 months to quit smoking by using patches. The patches may cause side effects that are similar to smoking cigarettes, including insomnia, headaches, and nausea. Some people are allergic to the tape used in patches and may get a skin reaction such as swelling or redness around the patch area.

A pill to stop smoking

If you would rather take a daily medicine to help you stop smoking, there are two options. Both require a prescription from your doctor.

Bupropion is an anti-depressant that also helps people stop smoking when it is taken at higher doses. We do not know exactly how bupropion stops people from smoking, but we do know that it works on many chemicals in the brain: to stop nicotine cravings. You begin taking bupropion 1 week before you want to quit smoking and continue taking it for at least 12 weeks. Some people take it for up to 6 months to make sure they do not begin smoking again. Possible side effects of bupropion include headache, insomnia, dizziness, rapid heartbeat, weight loss, and nausea. Some antiretroviral therapies may lower the levels of bupropion in the body. Check with your doctor or pharmacist to see if your medications interact with bupropion. If they interact, that does not mean you can't use bupropion; it may just mean that you will need close monitoring, extra support, or combination therapy with nicotine replacement to reach your goal of quitting.

Varenicline is a newer prescription medicine used to help people quit smoking. It reduces cravings and lessens the good feelings people get from smoking. You begin taking varenicline at least 1 week before you want to quit smoking and continue taking it for at least 12 weeks, maybe longer if you're worried about relapse. It does not interact with HIV medicines. However, people who have depression or heart disease should use varenicline very carefully. Some people have experienced changes in mood such as feeling agitated, hostile, or depressed; in rare cases, people have experienced psychosis or the desire to commit suicide. A recent study found that patients who used varenicline were slightly more likely to have heart attacks or strokes, although these heart attacks and strokes did not occur very often.

These severe side effects are rare, but it is important to talk with your doctor about which medicine might be best for you.

These medicines can be used with nicotine replacement therapies.

By-the-numbers:

  • People with HIV are more than twice as likely to smoke as people in the general population. In the United States, 40-75% of PLWHA smoke, while only 18% of the general population smokes.
  • Many PLWHA who smoke are highly dependent on nicotine (55-65%).

Beyond medications

Although there are many good medicines to support your goals of quitting smoking, the other "non-medicine" parts of your plan are equally important! These include having a supportive team around you. Friends, family members, and health care providers can help keep you on track. Your plan should include talking about reasons why you want to quit smoking, so you can remain inspired. Your plan should also include understanding when you typically smoke, how much you smoke, and why you smoke. Knowing these things can help you identify situations that tempt you to reach for a cigarette, so that you can avoid or work around them. You also can take advantage of many great telephone resources such as 1-800-QUIT-NOW for free counseling, advice, and services. It is not easy to quit smoking, but it is important for your health over the long run. If you've been thinking about quitting, start the conversation with your health care provider. Good luck!

VA can help

Download VA's My Smoking Cessation Workbook: A Resource for Patients
(1.55 MB)(PDF)