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

Author

Listed:
  • 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
    South African Medical Research Council, Cape Town, South Africa)

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.

Suggested Citation

  • 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, 2021. "An Emerging Syndemic of Smoking and Cardiopulmonary Diseases in People Living with HIV in Africa," IJERPH, MDPI, vol. 18(6), pages 1-12, March.
    • Handle: RePEc:gam:jijerp:v:18:y:2021:i:6:p:3111-:d:519371
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    References listed on IDEAS

    as
    1. Emmanuel Peprah & Elisabet Caler & Anya Snyder & Fassil Ketema, 2020. "Deconstructing Syndemics: The Many Layers of Clustering Multi-Comorbidities in People Living with HIV," IJERPH, MDPI, vol. 17(13), pages 1-7, June.
    2. Singer, Merrill, 1994. "Aids and the health crisis of the U.S. urban poor; the perspective of critical medical anthropology," Social Science & Medicine, Elsevier, vol. 39(7), pages 931-948, October.
    3. Agnieszka Strzelak & Aleksandra Ratajczak & Aleksander Adamiec & Wojciech Feleszko, 2018. "Tobacco Smoke Induces and Alters Immune Responses in the Lung Triggering Inflammation, Allergy, Asthma and Other Lung Diseases: A Mechanistic Review," IJERPH, MDPI, vol. 15(5), pages 1-35, May.
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    Cited by:

    1. Alissa C. Kress & Carlen Stadnik & Masauso Moses Phiri & Fastone M. Goma & Evelyn Twentyman, 2022. "Tobacco Use among HIV-Positive and HIV-Negative Women and Men in Zambia—Demographic and Health Survey, 2018," IJERPH, MDPI, vol. 19(7), pages 1-16, March.
    2. Emmanuel Peprah & Bronwyn Myers & Andre-Pascal Kengne & Nasheeta Peer & Omar El-Shahawy & Temitope Ojo & Barbara Mukasa & Oliver Ezechi & Juliet Iwelunmor & Nessa Ryan & Fatoumata Sakho & John Patena , 2022. "Using a Syndemics Framework to Understand How Substance Use Contributes to Morbidity and Mortality among People Living with HIV in Africa: A Call to Action," IJERPH, MDPI, vol. 19(3), pages 1-12, January.

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