Smoking might add to the woes of the HIV-infected, the first such study on Indian people living with HIV and AIDS (PLWHA) has revealed1. The study, conducted at a very small scale, also puts the spotlight on the need for broad-based research in this area of significant public health concern.

A significant number out of the 2.5 million PLWHA in India, many young, might be subjecting themselves to additional risk for several infectious and non-infectious complications by smoking tobacco. This might include malignancies and cardiovascular disorders.

In the pilot survey conducted among patients attending a government tuberculosis clinic in Madurai, Tamil Nadu, researchers found that 66% of HIV-infected men (without TB) had a history of smoking and 0.4% women shared a similar history. Among men who had both HIV and TB, the history of ever smoking was 76%.

Some more statistics from the study – among HIV-negative pulmonary tuberculosis patients, history of ever smoking was 73 per cent.

"While this pilot data does not demonstrate higher smoking rates among HIV-infected compared to uninfected TB patients, it does suggest that smoking is a significant co-morbidity that would need to be addressed," lead researcher S. Ramesh Kumar from the Indian Council of Medical Research unit says.

Smoking has been proved to alter the immunological mechanisms and suppress host defenses in the lungs. HIV-infected smokers have also been found to have a poorer response to antiretroviral therapy and a higher risk of death.

"HIV-infected individuals who smoke could be at a greater risk for developing TB and subsequently suffer higher morbidity and mortality than those who do not smoke. Interventions like physician's advice, nicotine replacement therapy and pharmacological agents like bupropion and varenicline have had varying degrees of success in making them quit smoking," Kumar and colleagues say in a paper in the Indian Journal of Medical Research.

Getting HIV-infected people to quit smoking could be more complex because of associated psychosocial problems like drug addiction, alcoholism and depression, Kumar says.

There has been no specific study yet to find the smoking prevalence or quit rate among HIV-infected persons in India. The researchers feel that more studies must be taken up as also clinical trials to test the efficacy of smoking cessation interventions in HIV infected persons in India.

They also suggest that counselling on smoking cessation should become one of the main components of primary care, especially in the management of HIV-infected persons.