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Smoking is Deadlier than HIV?

Wednesday, January 30, 2013 // Uncategorized

 This is a summary of an article from Journal Watch.  Smoking shortened lives more than HIV did.

For HIV-Infected Patients, Smoking Is Deadlier Than HIV

The striking numbers: 12.3 life-years lost from smoking, compared with 5.1 lost from HIV infection

Smoking is extremely common among HIV-infected patients. To quantify the contribution of smoking to mortality in HIV patients, researchers analyzed a median of 4 years of follow-up data from 2921 patients (78% men, 77% on antiretroviral therapy at baseline) in a Danish national HIV cohort and from 10,642 matched controls in the Danish general population. Each patient’s smoking status — current (any weekly tobacco use), previous, or never — was assessed at time of enrollment and held constant for purposes of analysis. Duration of smoking was not considered. Outcomes data came from Danish national registries.

In the HIV-infected cohort, analyses adjusted for HIV-related and other clinical variables revealed that all-cause mortality was more than fourfold higher, and non–AIDS-related mortality was more than fivefold higher, among current smokers than among never smokers. Some 12.3 life-years were lost from smoking, compared with 5.1 life-years lost from HIV infection.

The population-attributable risk for death related to smoking was about 62% in the HIV cohort and 34% in the control group. Compared with controls, HIV patients had roughly triple the excess mortality and life-years lost from smoking. The relative risk for death associated with smoking did not differ significantly between the two groups.

Comment: This study offers a striking message: HIV-infected smokers lose more life-years to smoking than to HIV. Whether smoking is merely a “traditional” risk factor or a pro-inflammatory factor that acts synergistically with HIV, it clearly influences life expectancy among HIV patients who are engaged in care. The findings underscore the importance of smoking-cessation efforts in HIV care; those include raising general awareness, promoting counseling and pharmacologic intervention, training providers, and designing interventions tailored to HIV patients. These compelling data may make it easier for clinicians to persuade patients that smoking poses an even greater risk than HIV infection.

— Virginia A. Triant, MD, MPH

Dr. Triant is an Instructor in Medicine at Harvard Medical School and an Infectious Diseases Specialist at Massachusetts General Hospital. She reports no conflicts of interest.

Published in Journal Watch HIV/AIDS Clinical Care January 28, 2013

Citation(s):

Helleberg M et al. Mortality attributable to smoking among HIV-1–infected individuals: A nationwide, population-based cohort study. Clin Infect Dis 2012 Dec 18; [e-pub ahead of print]. (http://dx.doi.org/10.1093/cid/cis933)

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