Lung Cancer Mortality Associated With Smoking and Smoking Cessation Among People Living With HIV in the United States

Abstract

IMPORTANCE Lung cancer has become a leading cause of death among people living with human immunodeficiency virus (HIV) (PLWH). Over 40% of PLWH in the United States smoke cigarettes; HIV independently increases the risk of lung cancer.OBJECTIVE To project cumulative lung cancer mortality by smoking exposure among PLWH in care.DESIGN Using a validated microsimulation model of HIV, we applied standard demographic data and recent HIV/AIDS epidemiology statistics with specific details on smoking exposure, combining smoking status (current, former, or never) and intensity (heavy, moderate, or light). We stratified reported mortality rates attributable to lung cancer and other non-AIDS-related causes by smoking exposure and accounted for an HIV-conferred independent risk of lung cancer. Lung cancer mortality risk ratios (vs never smokers) for male and female current moderate smokers were 23.6 and 24.2, respectively, and for those who quit smoking at age 40 years were 4.3 and 4.5. In sensitivity analyses, we accounted for nonadherence to antiretroviral therapy (ART) and for a range of HIV-conferred risks of death from lung cancer and from other non-AIDS-related diseases (eg, cardiovascular disease). MAIN OUTCOMES AND MEASURESCumulative lung cancer mortality by age 80 years (stratified by sex, age at entry to HIV care, and smoking exposure); total expected lung cancer deaths, accounting for nonadherence to ART. RESULTS Among 40-year-old men with HIV, estimated cumulative lung cancer mortality for heavy, moderate, and light smokers who continued to smoke was 28.9%, 23.0%, and 18.8%, respectively; for those who quit smoking at age 40 years, it was 7.9%, 6.1%, and 4.3%; and for never smokers, it was 1.6%. Among women, the corresponding mortality for current smokers was 27.8%, 20.9%, and 16.6%; for former smokers, it was 7.5%, 5.2%, and 3.7%; and for never smokers, it was 1.2%. ART-adherent individuals who continued to smoke were 6 to 13 times more likely to die from lung cancer than from traditional AIDS-related causes, depending on sex and smoking intensity. Due to greater AIDS-related mortality risks, individuals with incomplete ART adherence had higher overall mortality but lower lung cancer mortality. Applying model projections to the approximately 644 200 PLWH aged 20 to 64 in care in the United States, 59 900 (9.3%) are expected to die from lung cancer if smoking habits do not change.CONCLUSIONS AND RELEVANCE Those PLWH who adhere to ART but smoke are substantially more likely to die from lung cancer than from AIDS-related causes.

Safety and Efficacy of PD-1 Inhibitors Among HIV-Positive Patients With Non–Small Cell Lung Cancer

“…[1][2][3][4] Because HIV is an independent risk factor for lung cancer, and more than 40% of people living with HIV (PLWH) in the United States have a history of tobacco use, lung cancer has emerged as one of the leading overall causes of death in PLWH. [7][8][9] In fact, PLWH who adhere to antiretroviral therapy (ART) but smoke are more likely to die from lung cancer than from acquired immune deficiency syndrome (AIDS)related illnesses, highlighting the need to study effective lung cancer therapies among HIVpositive patients. 9 A number of concerns have been raised about including PLWH in cancer clinical trials, such as possible impaired efficacy of immune checkpoint inhibitors in immunosuppressed individuals, potential exacerbation of immune reconstitution inflammatory syndrome (IRIS) in patients recently started on ART, and unknown effects on other HIV-related opportunistic infections or malignances.…”

Impatto del fumo di sigaretta sulla mortalità a 10 anni in una coorte di pazienti con infezione da HIV.

“…Il trend di mortalità, legato a cause neoplastiche e cardiovascolari più strettamente connesse in termini biologici al fumo di sigaretta, mostra che il fattore di rischio fumo potrà avere un impatto maggiore nei decenni successivi con una popolazione che inevitabilmente tende a invecchiare. Recenti studi epidemiologici sulla mortalità per cancro del polmone hanno mostrato che pazienti HIV infetti, fumatori in terapia antiretrovirale, hanno una probabilità significativamente maggiore (da 6 a 13 volte) di morire per cancro del polmone che per cause AIDS relate (9). Nel periodo considerato in soggetti relativamente giovani al basale, la mortalità per causa epatica è risultata la più rilevante e associata alla positività per HCV e al fattore di rischio tossicodipendenza.…”

“…, AIDS-related (11); cardiovascular (9) and others (10). In a Cox analysis, the mortality was significantly higher in smokers compared with non smokers …”

Immediate Smoking Cessation Among People Living with HIV

“…The main outcomes and measures demonstrated cumulative lung cancer mortality by the age of 80 (stratified by sex, age at entry to HIV care, and smoking exposure); total expected lung cancer deaths accounting for non-adherence to ART (10).…”

“…Individuals with incomplete ART adherence had a higher overall mortality due to greater AIDS-related mortality risks but lower lung cancer mortality. Applying model projections to approximately 644,200 PLWH aged 20 to 64 in the United States, 59,900 (9.3%) are expected to die from lung cancer if smoking habits do not change (10).…”