HIV Patients Are 6 Times More Likely to Die From Smoking vs HIV

People living with human immunodeficiency virus (HIV) who currently smoke are 6 to 13 times more likely to die from lung cancer than other AIDS-related causes, according to the findings of a recent study.

It is well known that HIV increases the risk for lung cancer, and because more than 40% of the HIV population in the United States are smokers, the researchers aimed to better understand the mortality rate among this population.
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Using a microsimulation model of HIV, the researchers calculated the cumulative risk for lung cancer mortality by 80 years of age and total expected lung cancer deaths among people living with HIV. These estimates were based on demographic data and recent HIV/AIDS epidemiology statistics on smoking exposure (smoking status and intensity).

Participants were categorized as current, former, or never smokers and heavy, moderate, or light smokers. For moderate smokers at age 40 years, the lung cancer mortality risk ratio for men was 23.6 and for women was 24.2, compared with never smokers. For those who quit smoking at age 40 years, the risk ratio was 4.3 for men and 4.5 for women.

The researchers also conducted sensitivity analyses that adjusted for nonadherence to antiretroviral therapy (ART) and a range of HIV-conferred risks for death from lung cancer and other non-AIDS related diseases.

The estimated cumulative lung cancer mortality risk among men age 40 years with HIV was 28.9% for heavy smokers, 23% for moderate smokers, and 18.8% for light smokers. For women, the risk was 27.8% for heavy smokers, 20.9% for moderate smokers, and 16.6% for light smokers.

Among men had who quit smoking at age 40 years, the risk was 7.9% for heavy former smokers, 6.1% for former moderate smokers, and 4.3% for former light smokers. For women, this risk was 7.5% for former heavy smokers, 5.2% for former moderate smokers, and 3.7% for former light smokers.

The risk was 1.6% among men who had never smoked and 1.2% among women who had never smoked.

People living with HIV who adhered to ART but continued to smoke were 6 to 13 times more likely to die from lung cancer than from traditional AIDS-related causes, depending on their sex and smoking intensity.

“Those [people living with HIV] who adhere to ART but smoke are substantially more likely to die from lung cancer than from AIDS-related causes,” the researchers concluded.

—Melissa Weiss

Reference:

Reddy KP, Kong CY, Hyle  EP, et al. Lung cancer mortality associated with smoking and smoking cessation among people living with HIV in the United States [published online September 18, 2017]. JAMA Intern Med. doi:10.1001/jamainternmed.2017.4349.