Increased risk of Pneumocystis carinii and community-acquired pneumonia with tobacco use in HIV disease.
OBJECTIVE
Tobacco smoking-related diseases continue to be of great health concern for the public, in general, and may be particularly deleterious for immunosuppressed HIV-positive individuals, who exhibit widespread tobacco use.


METHODS
A total of 521 HIV-infected subjects consecutively admitted to Jackson Memorial Hospital between 2001-2002 were enrolled in the study. Research data included a medical history, details of tobacco and illicit drug use and complete computerized hospital information. Blood was drawn to obtain T lymphocyte profiles and viral load levels. Statistical analysis methods included Pearson, Student's t- and Chi-square tests and SAS Proc CATMOD.


RESULTS
Tobacco use was prevalent, with 65% of the 521 HIV-positive hospitalized patients being current smokers. Overall, current tobacco users reported smoking an average of 15+/-13 cigarettes per day for an average of 15+/-14 years, with 40% smoking more than one pack per day. Pulmonary infections accounted for 49% of the total hospital admissions: 52% bacterial pneumonias, 24% Pneumocystis carinii pneumonia (PCP), 12% non-tuberculous mycobacterial diseases (NTM), 11% tuberculosis and 1% bronchitis. Many of the respiratory patients (46%) had been on highly active antiretroviral therapy (HAART) for over six months and 42% had received PCP and/or NTM prophylaxis. After matching the cases by HAART and CDC stage, the hazardous risk of being hospitalized with a respiratory infection was significantly higher for smokers than non-smokers (95% CI 1.33-2.83; p=0.003). Respiratory infections were noted in (37%) of the HAART-treated patients, and most (67%) occurred in smokers. CATMOD analyses controlling for HAART, viral load and CD4, indicated that HIV-infected smokers were three times more likely to be hospitalized with PCP and twice as likely to be hospitalized with community-acquired pneumonia than non-smokers, with increased risk related to the number of cigarettes/day in a dose-dependent manner.


CONCLUSIONS
Tobacco use, which is widespread among HIV-infected subjects, increases the risk of pulmonary diseases, particularly PCP and CAP, two respiratory infections with high prevalence and morbidity risks even in the era of HAART.
Miguez-Burbano
Maria Jose
MJ
Division of Disease Prevention, Department of Psychiatry and Behavioral Sciences, University of Miami, School of Medicine, Miami, FL 33136, USA. mmiguez@med.miami.edu
Ashkin
David
D
Rodriguez
Allan
A
Duncan
Robert
R
Pitchenik
Arthur
A
Quintero
Noaris
N
Flores
Monica
M
Shor-Posner
Gail
G
D019380:Anti-HIV Agents / Q000627:therapeutic use; D016022:Case-Control Studies; D017714:Community-Acquired Infections / Q000209:etiology*; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D008297:Male; D018410:Pneumonia, Bacterial / Q000209:etiology*; D011020:Pneumonia, Pneumocystis / Q000209:etiology*; D012307:Risk Factors; D012907:Smoking; D019966:Substance-Related Disorders; D014026:Nicotiana
D019380:Anti-HIV Agents