Smoking-Related Health Risks Among Persons With HIV in the Strategies for Management of Antiretroviral Therapy Clinical Trial

Abstract

Objectives We sought to determine smoking-related hazard ratios (HRs) and population-attributable risk percentage (PAR%) for serious clinical events and death among HIV-positive persons, whose smoking prevalence is higher than in the general population. Methods For 5472 HIV-infected persons enrolled from 33 countries in the Strategies for Management of Antiretroviral Therapy clinical trial, we evaluated the relationship between baseline smoking status and development of AIDS-related or serious non-AIDS events and overall mortality. Results Among all participants, 40.5% were current smokers and 24.8% were former smokers. Adjusted HRs were higher for current than for never smokers for overall mortality (2.4; P<.001), major cardiovascular disease (2.0; P=.002), non-AIDS cancer (1.8; P=.008), and bacterial pneumonia (2.3; P<.001). Adjusted HRs also were significantly higher for these outcomes among current than among former smokers. The PAR% for current versus former and never smokers combined was 24.3% for overall mortality, 25.3% for major cardiovascular disease, 30.6% for non-AIDS cancer, and 25.4% for bacterial pneumonia. Conclusions Smoking contributes to substantial morbidity and mortality in this HIV-infected population. Providers should routinely integrate smoking cessation programs into HIV health care.

Smoking Cessation for People Living With HIV/AIDS: A Literature Review and Synthesis

“…28 Among HIV patients, quitting smoking also appears to convey substantial health benefits. For example, Lifson et al 26 reported that mortality among HIV patients in their sample was significantly higher throughout the follow-up period for current smokers than for former smokers. Current smokers were also more likely than former smokers to experience AIDS-related events (which include diseases meeting the revised CDC AIDS case definition as well as other conditions associated with HIV-related immunodeficiency, such as esophageal candidiasis), cardiovascular disease, non-AIDS cancers, and bacterial pneumonia.…”

“…Lifson et al 26 reported smoking data from a large (N = 5472) sample from the Strategies for Management of Antiretroviral Therapy clinical trial. Overall mortality was significantly higher for current than never-smokers.…”

HIV infection, aging and cardiovascular disease: epidemiology and prevention

“…4,22,[25][26][27][28][29][30][31] Compared with non-smokers, smokers have a two-fold or greater increased risk of MI 19 and CVD. 24,32 Although two studies have reported decreasing rates of smoking over time, in part suggesting that in an aging cohort, smoking rates are decreasing, 4,5 few data are available on actual rates of smoking as HIV-positive patients age. In the Swiss HIV Cohort Study, the prevalence of current smoking was lower among men older than 40 years compared with younger men (52.5% v. 64.3%, respectively), but not in women (53.4% v. 53.9%).…”

Translation of a comprehensive health behavior intervention for women living with HIV: the SMART/EST Women's Program

“…Translational research has addressed a variety of medical conditions (e.g., cardiovascular disease, diabetes, and HIV/AIDS) and has been applied to medical, behavioral, and biobehavioral interventions (e.g., the Diabetes Prevention Program) [2]. Translation of behavioral interventions for people living with HIV/AIDS (PLWHAs) that addresses multiple risk behaviors is especially appropriate, as PLWHAs have been identified as being at increased risk of comorbid health conditions, such as cardiovascular and pulmonary diseases, depression, diabetes, and addiction [3,4]. In addition, psychiatric disorders have also been associated with decrements in essential health behaviors for PLWHAs (e.g., antiretroviral medication adherence [5][6][7][8][9] and medical appointment attendance [10,11]) and with poorer overall mental health and quality of life [12,13].…”