Wednesday, December 26, 2012

Time To Stop Smoking: New Study Shows Deadly Effect of Smoking on People with HIV

Here is a study by Helleberg and colleagues looking at smoking-related mortality in HIV patients in Denmark. For people with HIV (in a country where HIV care is organized and antiretroviral therapy is free), smoking was associated with more years of life lost than HIV itself.

These authors looked at 2,921 people with HIV followed in the Danish HIV Cohort Study (from 1995-2010) with 10,642 controls taken from another large population-based cohort.

HIV positive smokers were 5.3 times more likely to die from a non-AIDS related death (cardiovascular disease, cancer, et cetera) than HIV positive non-smokers. AIDS related mortality was higher in HIV positive smokers, as well; they were 4 times more likely to die from an AIDS-related death than HIV positive non-smokers.

The authors estimate that a 35 year old HIV positive smoker has a life expectancy of approximately 63 years; an HIV positive non-smoker has a life expectancy of 78 years. In terms of years of life lost, smoking was associated with 12.3 years of life lost (versus only 5.1 years lost associated with HIV).

Although one could argue that these findings may be difficult to extrapolate to settings outside Denmark (where, again, HIV care is well organized and antiretrovirals are free), these findings are compelling and have implications for managing HIV positive patients worldwide. Although healthcare providers are well aware that smoking causes all sorts of health problems and is associated with increased mortality, this study quantifies the deadly effect of smoking on people living with HIV.

In an era where antiretrovirals have transformed HIV into a chronic illness, we need to re-double our efforts in counseling/ supporting HIV positive patients to stop smoking.

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