Health care providers urge all patients to stop smoking due to numerous health risks, but they should take a more stringent approach for those with HIV. Patients with HIV who smoke may have an increased risk of lung cancer mortality compared with the risk of dying from HIV, according to a new study published by JAMA Internal Medicine.
 
These findings suggest that healthcare providers should strongly advocate for smoking cessation and cancer screening should for patients with HIV.
 
“Smoking and HIV are a particularly bad combination when it comes to lung cancer,” said lead researcher Krishna Reddy, MD. “Smoking rates are extraordinarily high among people with HIV, and both smoking and HIV increase the risk of lung cancer.”
 
Although antiretroviral therapy (ART) has significantly extended the lives of patients with HIV, smoking may pose significant risks to this population. Patients with HIV who smoke are significantly more likely to develop lung cancer than HIV-negative patients who smoke, according to the study.
 
“Lung cancer is now one of the leading killers of people with HIV, but most of these deaths can be prevented,” said senior author Rochelle Walensky, MD.
 
In the study, the authors used a computer simulated model of the HIV population and estimated the risk of lung cancer based on smoking status, daily cigarette intake, and adherence to ART. The authors also accounted for the risk of other conditions, such as heart disease, that increase with smoking.
 
The authors project that 25% of patients who adhere to ART but continue to smoke will die from lung cancer, according to the study. However, only 6% of patients with HIV who quit smoking at age 40 will die from cancer, highlighting the importance of cessation.
 
The authors also discovered that HIV-positive patients on ART who smoke are up to 13 times more likely to die of lung cancer than HIV/AIDS, depending on smoking frequency and sex.
 
Unsurprisingly, heavy smokers are at a high risk of developing lung cancer. When these individuals did not strictly adhere to ART—raising their risk of dying from HIV/AIDS—lung cancer was found to be the cause of death for 15% of smokers, according to the study.
 
“Quitting smoking is one of the most important things that people with HIV can do to improve their health and live longer,” said co-author Travis Baggett, MD. “Quitting will not only reduce their risk of lung cancer but also decrease their risk of many other diseases, such as heart attack, stroke, and emphysema.”
 
Current estimates indicate that more than 40% of patients with HIV smoke. Since smoking is extremely common among this population, the authors estimated the total number of lung cancer deaths, accounting for smoking rates and imperfect adherence to ART.
 
The authors project that nearly 60,000 will die from lung cancer, which is about 10% of smoking and non-smoking patients treated for HIV in the United States, according to the study.
 
These findings suggest that smoking cessation should be a top priority for providers caring for HIV patients.
 
“These data tell us that now is the time for action. Smoking cessation programs should be integrated into HIV care, just like antiviral therapy,” Dr Reddy concluded.