Tobacco and HIV

Over 1.1 million people in the US are living with human immunodeficiency virus (HIV), and an estimated 40 percent smoke cigarettes. Lung cancer is the leading cause of cancer death among people living with HIV (PLH) on antiretroviral therapy. It is estimated that life expectancy among HIV-positive smokers is reduced by at least 16 years compared with HIV-positive nonsmokers and that 94 percent of lung cancer diagnoses among PLH could potentially be prevented by eliminating cigarette smoking in this population.

While tobacco use has been slowly declining in most high-income countries, including the U.S., it has continued to increase in other parts of the globe, shifting from high-income to low- and middle-income countries (LMIC). Already, a disproportionate share of the global tobacco burden falls on LMICs, where 84% of the world’s 1.3 billion current smokers reside. Tobacco use is associated with increased rates of HIV acquisition worldwide, and people living with HIV are more likely to use tobacco than the general population.

The high prevalence of cigarette smoking and the high incidence of tobacco-related cancer and other smoking-related diseases among PLH calls for swift action to intervene with this population to drive down tobacco use rates. However, evidence to guide the care of HIV-positive smokers is lacking. Few randomized clinical trials have rigorously and systematically tested evidence-based tobacco cessation interventions among PLH, and few studies have addressed patient-level, provider-level, and systems- or contextual level barriers to successful smoking cessation among PLH.

Funding for Tobacco and HIV Research

Improving Smoking Cessation Interventions among People Living with HIV (PLH)

To reach the long-term goal of reducing cigarette smoking rates among PLH, NCI is funding research to assess existing evidence-based smoking cessation interventions and/or to develop and test adaptations of evidence-based smoking cessation interventions, focusing on the unique barriers to cessation in this population.

In 2019, NCI awarded six grants under the RFAs (R01, R21) Improving Smoking Cessation Interventions among People Living with HIV (PLH). These awards support research to systematically test existing evidence-based smoking cessation interventions and/or develop and evaluate adaptations of evidence-based smoking cessation interventions for PLH in the US. The funded research will address crosscutting areas of health disparities, behavioral, and social sciences research, and inform dissemination efforts to reduce the incidence of tobacco-related disease and death among PLH, in accordance with the highest HIV/AIDS research priorities identified by NIH.

Tobacco Use and HIV in Low- and Middle-Income Countries

NCI is also interested in supporting research to develop and evaluate tobacco cessation interventions for people living with HIV and tailored to low resource environments.

NCI has awarded grants through multiple mechanisms, including two PARs (R01, R21) Tobacco Use and HIV in Low- and Middle-Income Countries. The primary aim of these funding opportunities is to support the development and evaluation of tobacco cessation interventions tailored to HIV-positive populations in low- and middle-income countries, including populations with co-morbidities, such as tuberculosis.

These are high-priority research areas for NCI, and we welcome new applications using the omnibus and parent funding opportunity announcements.

Selected Grants Funded in Areas Relevant to Tobacco Cessation among People Living with HIV (PLH)

PI Name(s) Organization Name Project Title Project Number
Cioe, Patricia Brown University A Peer Navigator Model to Improve Quit Attempts, Quitline Use, and Smoking Cessation Rates among HIV-positive smokers 1R21CA243906-01
Crothers, Kristina
Catz, Sheryl
McClure, Jennifer
Seattle Institute for Biomedical/Clinical Research Improving the Reach and Effectiveness of Smoking Cessation Services Targeted to Veterans Living with HIV 1R01CA243907-01
Edelman, Jennifer
Bernstein, Steven
Yale University A SMART Approach to Treating Tobacco Use Disorder in Persons Living with HIV 1R01CA243910-01
Himelhoch, Seth University of Maryland Baltimore Optimizing Smoking Cessation Interventions for PLWH in Nairobi, Kenya 5R01CA225419-02
Marhefka, Stephanie University of South Florida The Positively Quit Trial: Addressing disproportionate smoking rates among people living with HIV 1R01CA243800-01
Pacek, Lauren   Vilardaga, Roger Duke University Early-phase Studies of a Tailored Evidence-Based Smoking Cessation mHealth App for Persons Living with HIV 1R21CA243911-01
Schnoll, Robert University of Pennsylvania Testing Novel Pharmacogenetic and Adherence Optimization Treatments to Improve the Effectiveness of Smoking Cessation Treatments for Smokers with HIV 1R01CA243914-01
Shuter, Jonathan Albert Einstein College of Medicine RCT of an Internet Cessation Program Plus Online Social Network for HIV + Smokers 5R01CA192954-07
Vidrine, Damon H. Lee Moffitt Cancer Center & Research Institute Randomized Trial of Automated Video-Assisted Smoking Treatment for People Living with HIV 1R01CA243552-01