Background:  Smoking prevalence among HIV⁺ populations is high, with estimates of 47 to 70%. Smoking poses a well-known risk for conditions such as cancer, vascular disease, and chronic lung disease; HIV infection plays an additive role in some of them. HAART has dramatically improved morbidity and mortality, leading to a healthier and aging HIV⁺ population. Smoking cessation is an increasingly important aspect of HIV care.

Methods:  HIV⁺ individuals referred by their physicians were enrolled in a randomized controlled smoking cessation trial. Participants were not required to set a quit date, were currently smoking 5 or more cigarettes per day, and could not have contraindications to using the nicotine patch. Participants were randomized to receive either a brief 2-session intervention modeled on Public Health Service (PHS) guidelines, or a more intensive 4-session motivational counseling intervention. Any participant willing to set a quit date was provided 8 weeks of nicotine patches.

Results:  We screened 599 participants and randomized 444, of whom 212 joined the motivationally enhanced (ME) group and 232, the standard care (SC) intervention group. Of the total, 72% completed the 6-month follow-up visit; 63% were male; 52% white, 16% Hispanic, 18% black; 6-month quit rates by intent-to-treat analysis was 9% overall (9% ME, 10% SC, p = 0.76). Higher quit rates were seen among Hispanics (19% overall, 14% ME, 24% SC) and lowest among blacks (5% overall, 9% ME, 0% SC), with significant difference in the standard care arm (p = 0.01). Failure to use nicotine replacement predicted smoking at 6 months (p <0.05). Multivariate predictors of 6-month smoking abstinence among patch users included black race vs white (p = 0.003), baseline self-efficacy or change in self-efficacy to refuse cigarettes (p <0.001), change in decisional balance (p = 0.003).

Conclusions:  Although 73% of participants set a quit date and 68% used the nicotine replacement patch, 6-month quit rates were low with no difference between the motivationally enhanced group and the standard care intervention group. Failure to use the nicotine patch predicted smoking at the 6-month visit. Significant differences occurred in quit rates by race. Self-efficacy and decisional balance variables were found to mediate the relationship between nicotine patch use and 6-month abstinence. Brief and frequent contacts focused on nicotine patch use were effective in smoking cessation among HIV⁺ patients.