Date of Award

Fall 2011

Degree Type

Thesis

Degree Name

Doctor of Philosophy (PhD)

Department

Health Research Methodology

Supervisor

Marek Jozef Smieja

Co-Supervisor

Lehana Thabane

Language

English

Committee Member

Andrew McIvor, Fiona Smaill

Abstract

Cigarette smoking is prevalent in HIV-infected people, resulting in higher mortality rate and more premature heart and lung diseases in the highly active antiretroviral therapy era. Smoking is a modifiable risk factor for these adverse outcomes and smoking cessation in HIV-positive smokers is feasible, although further efforts are needed to improve smoking cessation programs in HIV-positive persons.

In this thesis, I examined the role of smoking in mortality and morbidity in HIV-positive Ontarians, and piloted a smoking cessation program featuring a novel smoking cessation aid, varenicline, in HIV-infected smokers. In addition, I explored three different methods to resolve missing data, by excluding, grouping and multiply imputing missing data. I adopted three different study designs in my thesis studies: retrospective cohort, cross-sectional and open label study.

We found smoking prevalence in HIV-infected people was consistently higher than in the general population. Smoking was associated with a higher risk of death, of respiratory symptoms, hospitalization and chronic obstructive pulmonary disease, and with reduced lung function and less CD4-T-lymphocyte improvement over time. We found varenicline was as effective in HIV-positive smokers as in non-HIV smokers reported by previous studies.

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