January 6, 2020 0 By FM

There is broad encumbrance of tobacco usage with respect to its accessibility in various forms and magnitude in India. Different range of factors such as social, environmental, psychological and genetic are associated with tobacco use not confined to an individual’s behavior. More emphasis prevails on socio-economic factors as people lack the resources required to combat the ill effects or morbidities associated with tobacco consumption. Dependency on tobacco use, its type and amount along with, divergence in the prevalence of tobacco consumption amongst higher and lower socio-economic groups, exacerbate the differences in the disease burden contributed by tobacco such as cardiovascular disease, cancer, and pulmonary disease.

South-East Asia has a very high usage of tobacco by HIV-positive individuals, consumed in the form of sniffing, chewing and smoking products. As we all know, HIV continues to be a prime public health concern not only at the national level but even at a global scale with more than 32 million lives affected so far as per WHO. Human immunodeficiency virus (HIV) is mainly due to sexually transmitted infection (STI) or by sharing needles or other drug equipment with someone who has HIV. It harms your body’s infection fighters, the cells of the immune system called CD4 cells, or T cells. With the passage of time, HIV destroys many of these cells, making your body powerless to fight off infections and disease. When this happens, HIV leads to AIDs, a chronic, potentially life-threatening condition. HIV leads to detrimental interactive prolonged inflammatory and immunosuppressive effects on the respiratory system, which infers that the system is very vulnerable. In case of smoking, it escalates the hazard of developing infections, as well as lung cancer and obstructive lung disorders. The acute consumption of tobacco also increases the chances of being affected by infections like bacterial pneumonia and pneumocystis pneumonia, a dangerous lung infection. It can also develop conditions that affect the mouth, such as oral candidiasis (thrush) and oral hairy leukoplakia. The risk of having oral candidiasis increases with low CD4 cells resulting in a poor response to antiretroviral therapy (ART). 

Many people living with HIV have high levels of lipids such as cholesterol and/or triglycerides in their blood. Due to high cholesterol, you can develop fatty deposits in your blood vessels. In time, the free flow of blood through arteries is not easy due to fast development of deposits. Tobacco smoke compounds this problem, by making your blood vessels stickier. Thus, making it easier for plaque to clog your arteries and cause a heart attack or stroke. As per literature, HIV patients may only lose about five years of life due to HIV. However, if they consume tobacco-related products, they may lose as much as 12 years of life. Presumptively, fatality chances are double with tobacco usage in HIV positive individuals rather than HIV infection itself. 

In spite of such bitter consequences, many lives are lost due to tobacco consumption by HIV-positive people. Dr. Vikas Punamiya, an M.D. in Tuberculosis & Respiratory Diseases and also founding directors of Advanced Respiratory Interventions & Sleep Evaluation (ARISE) Medical Research Centre stated that “Tobacco consumption among HIV people reduces the effects of HIV drugs and the patients are likely to experience side effects than any benefits. Smoking or the use of smokeless tobacco products have more of an effect on HIV-positive individuals with the risk of acquiring metastatic tumor and on less risk with low CD4 count, hepatitis C, or an AIDS. So, an integrated approach with focus on cessation and harm reduction from tobacco has the impact to alter multiple causes of disease.”

Tobacco harm reduction strategies are based on the utilization of innovative tobacco products and programs, reduced tobacco consumption and pharmaceutical medication. Given the individual benefit of smoking cessation, programs and practices to assist individuals who smoke should be one of the primary focus in modern HIV care. People living with HIV along with consumption of tobacco have a lack of confidence harm reduction interventions like nicotine replacement prescribing, competing priorities, lack of skills or knowledge, uncertainty around referral pathways and lack of confidence in the patient’s ability to quit. 

“In India in 2010, an estimated 368,127 deaths were attributable to the use of Indian Smokeless tobacco products. The tendency to use smokeless tobacco such as snuff or chewing tobacco over smoking is higher in women than men. Given the current scenario, the health crisis related to Indian smokeless tobacco use is largely unreported and unregulated. There is no appropriate data available to help justify the percentage of tobacco constituents that should be present in the commercial tobacco products available in India in order to reduce the harm. Usually, the focus is not given to smokeless tobacco users to quit the use of smokeless tobacco products compared to tobacco users”, as said by Nilesh Jain, Director of Harm Reduction Research and Innovation Center (HRRIC). “ The impact on overall public health is largely uncharacterized, let only consider the introduction of reduced-risk products (RRPs) or alternate less harmful products which will reduce the adverse effects of tobacco. At HRRIC, our vision is to propose such harm reduction intervention which will benefit the public health and reduce the harm caused by such substances,” he adds

Despite tremendous research on smoking toxicity in relation to HIV, the impact of smokeless tobacco products on HIV has been dealt marginally. The consequences of AIDS programs are below the set targets, although there is an enormous unveiling of therapeutic programs and endeavor to integrate HIV services at the National scale. Based on this, its mandate to carry out research activity, awareness programs, training serving for policy regulation to be formed forbidding mortality owing to HIV and smokeless tobacco products and ultimately for human well being. The introduction of Tobacco cessation programs has been advocated by several international bodies. 

Mapping the current issue, the harm reduction framework is considered to be the most cost-effective tobacco cessation intervention for HIV-positive individuals. The endeavor of reducing harm related to tobacco products for people living with HIV can include programs in regard to retroactive determination and transcription of tobacco usage, also stipulating of cessation proceeding; flaring awareness to individuals rendered to health-care and ability on the provision of cessation services among HIV-positive individuals.