HIV & smoking in India.

There are approximately 2.5 million people living with HIV/AIDS (PLWHA) in India - the young being particularly vulnerable. The prevalence of smoking has increased in India especially among rural, lower socio-economic and illiterate men. Studies have shown that HIV-infected smokers may be at additional risk for several infectious and non-infectious complications, including malignancies and cardiovascular events. Smoking alters immunological mechanisms and suppresses host defenses in the alveolar environment. 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. Currently available smoking cessation interventions like physician’s advice, nicotine replacement therapy and pharmacological agents like bupropion and varenicline have had varying degrees of success. Smoking cessation intervention in the HIV-infected population might be more complex because of associated psychosocial problems like drug addiction, alcoholism, depression, etc. More research including clinical trials testing the efficacy of smoking cessation interventions in HIVinfected persons is required in India. In addition to public health measures like banning smoking in public places and raising tobacco tax, comprehensive guidelines for health workers can help address this problem. Counselling on smoking cessation should be one of the main components of primary care, especially in the management of HIV-infected persons. This review highlights the importance of smoking cessation among HIV-infected persons in India.

Clinical profile of HIV in India.

The clinical course of human immunodeficiency virus (HIV) disease and pattern of opportunistic infections varies from patient to patient and from country to country. The clinical profile of HIV disease in India includes a wide range of conditions like tuberculosis, cryptococcal meningitis, popular pruritic eruptions, and cytomegalovirus retinitis, among others. Tuberculosis is the most common opportunistic infection in Indian patients with HIV. Occurrence of various AIDS-associated illnesses determines disease progression. Mean survival time of Indian patients after diagnosis of HIV is 92 months. In this review, we discuss the clinical profile of HIV disease through an organ system-based approach. With the availability of antiretroviral therapy at lower cost, the clinical profile of HIV disease in India is now changing to include drug-related toxicities and immune reconstitution syndrome.