An Emerging Syndemic of Smoking and Cardiopulmonary Diseases in People Living with HIV in Africa

Emmanuel Peprah, Mari Armstrong-Hough, Stephanie H. Cook, Barbara Mukasa, Jacquelyn Y. Taylor, Huichun Xu, Linda Chang, Joyce Gyamfi, Nessa Ryan, Temitope Ojo, Anya Snyder, Juliet Iwelunmor, Oliver Ezechi, Conrad Iyegbe, Paul O’Reilly and Andre Pascal Kengne
Additional contact information
Emmanuel Peprah: School of Global Public Health, New York University, New York, NY 10012, USA
Mari Armstrong-Hough: School of Global Public Health, New York University, New York, NY 10012, USA
Stephanie H. Cook: School of Global Public Health, New York University, New York, NY 10012, USA
Barbara Mukasa: Mildmay Uganda, Kampala, Uganda
Jacquelyn Y. Taylor: School of Nursing, Columbia University, New York, NY 10032, USA
Huichun Xu: Division of Endocrinology, Diabetes and Nutrition, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA
Linda Chang: Department of Neurology, University of Maryland School of Medicine, Baltimore, MD 21201, USA
Joyce Gyamfi: School of Global Public Health, New York University, New York, NY 10012, USA
Nessa Ryan: School of Global Public Health, New York University, New York, NY 10012, USA
Temitope Ojo: School of Global Public Health, New York University, New York, NY 10012, USA
Anya Snyder: School of Global Public Health, New York University, New York, NY 10012, USA
Juliet Iwelunmor: College for Public Health and Social Justice, Saint Louis University, St. Louis, MO 63103, USA
Oliver Ezechi: Nigerian Institute of Medical Research, Lagos, Nigeria
Conrad Iyegbe: Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, New York, NY 10029, USA
Paul O’Reilly: Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, New York, NY 10029, USA
Andre Pascal Kengne: Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, New York, NY 10029, USA

IJERPH, 2021, vol. 18, issue 6, 1-12

Abstract: Background: African countries have the highest number of people living with HIV (PWH). The continent is home to 12% of the global population, but accounts for 71% of PWH globally. Antiretroviral therapy has played an important role in the reduction of the morbidity and mortality rates for HIV, which necessitates increased surveillance of the threats from pernicious risks to which PWH who live longer remain exposed. This includes cardiopulmonary comorbidities, which pose significant public health and economic challenges. A significant contributor to the cardiopulmonary comorbidities is tobacco smoking. Indeed, globally, PWH have a 2–4-fold higher utilization of tobacco compared to the general population, leading to endothelial dysfunction and atherogenesis that result in cardiopulmonary diseases, such as chronic obstructive pulmonary disease and coronary artery disease. In the context of PWH, we discuss (1) the current trends in cigarette smoking and (2) the lack of geographically relevant data on the cardiopulmonary conditions associated with smoking; we then review (3) the current evidence on chronic inflammation induced by smoking and the potential pathways for cardiopulmonary disease and (4) the multifactorial nature of the syndemic of smoking, HIV, and cardiopulmonary diseases. This commentary calls for a major, multi-setting cohort study using a syndemics framework to assess cardiopulmonary disease outcomes among PWH who smoke. Conclusion: We call for a parallel program of implementation research to promote the adoption of evidence-based interventions, which could improve health outcomes for PWH with cardiopulmonary diseases and address the health inequities experienced by PWH in African countries.

Keywords: syndemics; cardiovascular disease; smoking; tobacco; low- and middle-income countries; HIV/AIDS (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2021
References: View references in EconPapers View complete reference list from CitEc
Citations: View citations in EconPapers (2)

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