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Smoking more harmful than HIV in patients adhering to ART
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For patients with HIV who adhere to their treatment regimen but smoke cigarettes, smoking reduces life expectancy by about twice as much as HIV, according to the results of a United States-based modelling study.
Even when accounting for imperfect ART adherence and missed follow-up care, the decrease in life expectancy because of smoking cigarettes was similar to such a loss from HIV among men with HIV in the U.S., Krishna P. Reddy, MD, of Massachusetts General Hospital and Harvard Medical School, and colleagues wrote in The Journal of Infectious Diseases.
According to Reddy and colleagues, over 40% of HIV patients in the U.S. smoke — a rate more than twice as high as the general population — and an additional 20% are former smokers.
Reddy said factors associated with smoking cigarettes such as depression and substance abuse are common among people living with HIV, which may contribute to the high smoking rate in this population. Further, Reddy said, health care workers may be less likely to discuss smoking cessation with HIV-infected individuals than they are with other patients.
“Before the widespread use of ART, most people with HIV did not survive long enough to experience the consequences of smoking, and thus smoking was not commonly recognized as a threat to their health,” Reddy told Infectious Disease News. “Though the life expectancy of people with HIV has improved, smoking cessation interventions have not been widely integrated into HIV care programs. Few studies have examined smoking cessation interventions in people living with HIV to see what is most effective in helping them to quit.”
Associated loss of life higher for smoking than HIV
Reddy and colleagues used Massachusetts General Hospital’s Cost-Effectiveness of Preventing AIDS Complications model for the U.S. to project the life expectancy of HIV patients based on smoking status, sex and age at entry to HIV care in cohorts of 1 million individuals.
Researchers found that smoking cigarettes reduces life expectancy by about twice as much as HIV in infected patients who adhere to their treatment regimen.
Source: CDC
They calculated years of life lost to smoking by comparing HIV patients receiving similar care who currently smoke to those who never smoked. Years of life lost to HIV were calculated by subtracting the life expectancy of HIV-positive smokers from HIV-negative smokers.
Life expectancy among HIV-infected current smokers aged 40 years who perfectly adhere to ART was 68.6 years for men. The life expectancy loss due to smoking in these individuals was 8.6 years — more than double the 3.5-year loss for HIV infection. Among women in the same group, life expectancy was 72.1 years with losses for smoking at 8.2 years and HIV infection at 4.3 years.
Among HIV patients aged 40 years who did not adhere perfectly to their treatment regimen, the simulated loss associated with smoking was 6.7 years in men — similar to a 6.9-year loss associated with HIV infection. In women, the losses were 6.9 years for smoking and 8.3 years for HIV infection.
According to Reddy, studies have found that HIV infection independently increases the risks for developing serious medical outcomes such as heart attacks, emphysema and lung cancer that are already associated with smoking, making HIV infection and smoking a particularly dangerous combination.
“Smoking is now the leading killer of people with HIV in the U.S. who are receiving treatment,” Reddy said. “Quitting smoking can greatly improve their lifespan, and it is never too late to quit.”
Smoking cessation
Smoking cessation must be prioritized in adults living with HIV, Keri N. Althoff, PhD, MPH, associate professor of epidemiology in the Johns Hopkins Bloomberg School of Public Health wrote in a related editorial.
Althoff said this can lead to an increase in the quantity — and likely quality — of life among these patients.
“By showing that smoking cessation results in a greater gain in life expectancy than ART initiation at higher CD4+ T-cell counts or improved adherence to ART, there should be renewed urgency to implement smoking cessation programs, thereby continuing to shift the paradigm of HIV care to the increasingly important prevention of comorbidities after ART initiation,” Althoff wrote. – by Gerard Gallagher
Disclosures: Althoff reports receiving personal fees from Gilead Sciences outside the submitted work for service on medical advisory boards. The researchers report no relevant financial disclosures.
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