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Smoking cuts life expectancy in HIV more than AIDS does

People with HIV who smoke are 6-13 times more likely to die from lung cancer than AIDS-related causes

Louise Prime

Wednesday, 20 September 2017

Lung cancer is now a leading cause of death among people living with human immunodeficiency virus (HIV) – and for those adhering to their antiretroviral therapy but who continue to smoke, it is far more likely to kill them than causes related to acquired immune deficiency syndrome (AIDS), according to US research* published in JAMA Internal Medicine. The study authors have called for smoking cessation to become a priority in the care of people living with HIV to reduce the burden of lung cancer.

A team from Massachusetts General Hospital in Boston entered standard demographic data and recent HIV/AIDS epidemiology statistics, as well as specific details on smoking exposure – combining smoking status (current, former, or never) and intensity – into a computer-simulated model. They used this to project cumulative lung cancer mortality by the age of 80, by smoking exposure, among people living with HIV under medical care in the US. They also estimated total expected lung cancer deaths, accounting for non-adherence to antiretroviral therapy.

They reported that for men who began HIV care at the age of 40 and continued to smoke, cumulative lung cancer mortality by the age of 80 was 28.9% for heavy smokers, 23% for moderate smokers, and 18.8% for light smokers. For those men who quit smoking at the age of 40, the respective rates were 7.9%, 6.1% and 4.3% – compared with just 1.2% in men who had never smoked.

For women who entered HIV care at 40 years old and continued smoking, cumulative lung cancer mortality by the age of 80 was 27.8% for heavy smokers, 20.9% for moderate smokers, and 16.6% for light smokers; for women who quit at 40 years old, the rates were 7.5%, 5.2% and 3.7%; while for women who had never smoked it was 1.2%.

The researchers said the results from their model suggested that, for people with HIV who were adherent to their antiretroviral therapy but continued to smoke, they were substantially more likely to die from lung cancer than from traditional AIDS-related causes, depending on smoking intensity and sex.

They estimated that about 59,900 of the 644,200 people living with HIV and receiving care, who are aged 20-64 years, would be expected to die from lung cancer before the age of 80 if smoking habits do not change – although they acknowledged that as theirs was a model-based study, it had limitations.

They concluded: “Using a microsimulation model, we found that antiretroviral-adherent people living with HIV in the United States who smoke cigarettes are 6 to 13 times more likely to die from lung cancer than from AIDS-related causes …

“Clinicians caring for PLWH [people living with HIV] should offer guideline-based behavioural and pharmacologic treatments for tobacco use. Lung cancer is now a leading cause of death among PLWH, but smoking cessation can greatly reduce the risk. Lung cancer prevention, especially through smoking cessation, should be a priority in the comprehensive care of PLWH.”

The deputy editor of JAMA Internal Medicine commented:** “For all of our patients who smoke – including those with HIV – at the top of our agenda must be helping them to stop smoking through the use of quit lines, nicotine replacement therapy, and prescriptions for bupropion and varenicline. Studies show that we underuse these evidence-based treatments. Compared with arresting the replication of HIV, can it really be beyond our abilities to arrest the harms of tobacco?”


* Reddy KP, Kong CY, Hyle EP, et al. Lung cancer mortality associated with smoking and smoking cessation among people living with HIV in the United States. JAMA Intern Med. Published online September 18, 2017. doi:10.1001/jamainternmed.2017.4349.

** Katz MH. If we are smart enough to stop HIV from replicating, why can’t we help people to stop smoking? JAMA Intern Med. Published online September 18, 2017. doi:10.1001/jamainternmed.2017.4365

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