Letters to the Editor
To the Editors:
The increase in cardiovascular risk (CVR) among HIV-infected patients subjected to antiretroviral therapy1 has given rise to growing concern over modifiable CVR factors. Among these, smoking cessation is the measure, which could contribute most to reduce CVR in HIV-infected patients.2 Varenicline has demonstrated its usefulness in application to smoking cessation among patients without HIV infection,3-5 and although its metabolic profile does not suggest the possibility of drug interactions, no studies have been published on this drug in patients subjected to antiretroviral therapy. The present study describes our experience in treatment with varenicline and antiretroviral therapy.
Of a total of 166 patients administered antiretroviral therapy in our clinic, 70% were smokers. In those with undetectable viremia, and in addition to the usual control of other risk factors, we supplied written information advising smoking cessation. Those patients who showed interest and who had no psychiatric history or depressive symptoms were appointed for a specific visit in which the message relating to smoking cessation was reinforced (informative leaflets, talks in MP3, sweets to replace tobacco, baseline co-oximetry, and so on), with provision of the first 15 days of varenicline treatment free of charge. After 15 days, the patients were again seen to assess tolerance, check abstinence based on co-oximetry, and reinforce motivation. Varenicline was prescribed for another 2 months, and clinical and co-oximetry controls were made after 3 and 6 months.
Of the 22 patients who accepted to participate in the program and who received the free samples of varenicline, 3 failed to report to the control visit after 15 days. These subjects later explained that they had not completed the treatment due to a lack of motivation. Of the remaining 19 patients, 1 female (on treatment with tipranavir, ritonavir, stavudine, and lamivudine) abandoned in the first week because of important vomiting, headache, and discomfort. Among the remaining 18 subjects, nausea was reported in 5 cases and restlessness and sleep disturbances in 6 cases. In no patient were these problems a cause for treatment interruption, however.
Six patients were shown to be abstinent by co-oximetry after 3 months versus 5 after 6 months. The rest of the individuals returned to their usual levels of tobacco consumption. Although treatment was recommended for 2 months, only 2 patients completed this treatment because of financing problems. The mean duration of treatment was 30 days.
In a highly selected group of patients with HIV subjected to antiretroviral therapy, the results and tolerance recorded for varenicline are similar to those published in relation to patients without HIV infection. The cost of the medication complicates treatment.
Carlos Tornero, PhD
Internal Medicine Department, Hospital Gandia
1. The Data Collection on Adverse Events of Anti-HIV Drugs (DAD) Study Group. Combination antiretroviral therapy and the risk of myocardial infarction. N Engl J Med
. 2003;349:1993- 2003.
2. Tornero C, Santamaria A, Gil E, et al. Indices de riesgo cardiovascular en pacientes con infección por el virus de la inmunodeficiencia humana en tratamiento antirretroviral efectivo. Med Clin (Barc)
3. Hays JT, Ebbert JO. Varenicline for tobacco dependence. N Eng J Med
4. Eisenberg MJ, Kristian MPH, Filion MSc, et al. Pharmacotherapies for smoking cessation: a meta-analysis of randomized controlled trials. CMAJ
. 2008;179: 135-144.
5. Ranney L, Melvin C, Lux L, et al. Systematic review: smoking cessation intervention strategies for adults and adult special populations. Ann Intern Med