604. Impact of Substance and Alcohol Abuse on Smoking Related Behaviors When Using a Smoking Cessation Decisional Algorithm Among People Living with HIV (PLWH)
Session: Poster Abstract Session: HIV: Management and Clinical Outcomes
Thursday, October 4, 2018
Room: S Poster Hall
Posters
  • IDSA Poster 2018 Final PDF.pdf (443.8 kB)
  • Background: Compared to the general population, PLWH have higher rates of tobacco use. We performed a prospective single arm pilot study of the real-world feasibility of integrating an ambulatory smoking cessation decisional algorithm in our HIV clinic. We hypothesized that patients with drug and alcohol abuse would have a smaller change in smoking related behaviors.

    Methods: Participants were PLWH attending our clinic and smoking at least 5 cigarettes/day regardless of their motivation to quit (N=60). Each participant had an initial visit and 2 phone visits (+1 and +3 months). Participants completed surveys via computer during the first visit and by phone in the follow-ups. Additional clinical data was collected via chart review.

    Results: Participants had a mean age of 48, were mostly African-American(72%) and male(67%) with well controlled HIV (mean CD4 622, undetectable viral load in 70%). The mean AUDIT score to assess for alcohol abuse did not change over the 3 time points (7.1;7.2;7.6, median 4;5;5). A score of 8 or higher indicates harmful alcohol consumption and 23% of patients met the criteria. Lifetime self-reported treatment for substance abuse was high (35%). DAST score for assessing substance abuse was used and mean scores decreased slightly over time (2.3;1.2;0.93, median 2;0;0). A score of 6 or higher indicates a substance use disorder and 15% met that criteria at baseline, 3% at 3 months. Chart review had similar results with 18% having a diagnosis of substance abuse and 20% with alcohol abuse. Overall participants (n=60) showed a decrease in tobacco use, with an average of 14 cigarettes/day at baseline and 7 cigarettes/day at 3 months (p=0.001). Patients with a diagnosis of substance abuse had a baseline average of 12 cigarettes/day and 6 cigarettes/day at 3 months (reduction 6). For those with an alcohol abuse diagnosis, baseline was 16 cigarettes/day and at 3 months, 10 cigarettes/day (reduction 6). The change over time was not significantly different between the groups.

    Conclusion: People living with HIV who smoke are a complex group of patients who commonly have concurrent or historical substance and alcohol abuse. A substance and alcohol abuse diagnosis did not impact the decrease in tobacco use seen with implementation of a decisional algorithm.

    Madelyne C. Bean, PharmD, Associates in Family Medicine, Fort Collins, CO and Lauren E. Richey, MD, MPH, Louisiana State University Health Sciences Center New Orleans, New Orleans, LA

    Disclosures:

    M. C. Bean, None

    L. E. Richey, None

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