Smoking Exacerbates Death Risk in HIV

Undeniable positive strides have been made in the field of HIV treatment and management. An HIV diagnosis is no longer the killer it once was, and more infected patients are living into old age.

However, patients with HIV are three times more likely to smoke cigarettes than the general population, which means that about 40% of people with HIV are smokers. Now, a new study in The Journal of Infectious Diseases found that these people are more likely to die from the smoking than from the actual virus.

Antiretroviral therapy (ART) is so effective in some patients that it can result in a blood test with an undetectable viral load. This can help preserve and restore the immune system, as well as improve quality of life. So, for someone with HIV who consistently takes their medications, if they are also a smoker, the cigarettes will more likely be the bigger contributor to death.

How did the researchers make this discovery? They used a computer simulation of HIV in order to determine how smoking status impacts life expectancy. Previous research has tried to figure out this correlation as well, but unlike those studies conducted in Europe, this one took nonadherence and low retention in the United States into consideration.

“Even when accounting for typical rates of treatment nonadherence and missed follow-up care in the US, the study found that for men with HIV, the life expectancy loss associated with smoking was similar to that from HIV,” said a statement from the Infectious Diseases Society of America (IDSA).

One example, presented by the team, was if someone with HIV started treatment at age 40 and continued to smoke. A man would lose 6.7 years of life expectancy and a woman would lose 6.3 years (in comparison with people with HIV who never smoked). But if they decided to smoke when they entered treatment at age 40, the man would regain 5.7 years of life expectancy and the woman would regain 4.6 years.

“Now that HIV-specific medicines are so effective against the virus itself, we also need to add other interventions that could improve and extend the lives of people with HIV,” said Krishna P. Reddy, MD, of Massachusetts General Hospital and Harvard Medical School.

Reddy went on to explain that even an older person with HIV, like age 60, would increase their lifespan if they quit smoking as well. “We actually quantify the risk, and I think providing those numbers to patients can help put their own risks from smoking in perspective,” she said.

This one lifestyle change could give years back to someone’s life who has HIV — and at the end of the day, isn’t that the goal?