title: Impact of cigarette smoking on mortality in HIV-positive and HIV-negative veterans.
abstract: It is unknown whether smoking confers similar mortality risk in HIV-positive as in HIV-negative patients. We compared overall mortality stratified by HIV and smoking of 1,034 HIV-positive block-matched to 739 HIV-negative veterans, enrolled 2001-2002 in the Veterans Aging Cohort 5 Site Study. Adjusted incidence rate ratios (IRR) for mortality were calculated using Poisson regression. Mortality was significantly increased in HIV-positive veterans according to both smoking status and pack-years in unadjusted and adjusted analyses (adjusted IRR 2.31, 95% confidence interval [CI] 1.53-3.49 for HIV-positive current smokers and IRR 1.32, 95% CI 0.67-2.61 for HIV-negative current smokers). Comorbid diseases were also significantly increased according to smoking status and pack-years. Current smoking is associated with poor outcomes; even lower levels of exposure appear to be detrimental in HIV-infected veterans. These findings support the need for improvements in smoking cessation and for studies of mechanisms and diseases underlying increased mortality in smokers with HIV.
authors.affiliation: Department of Internal Medicine, VA Connecticut Healthcare System, West Haven, CT 06516, USA. kristina.crothers@yale.edu
authors.forename: Kristina
authors.initials: K
authors.lastname: Crothers
authors.forename: Joseph L
authors.initials: JL
authors.lastname: Goulet
authors.forename: Maria C
authors.initials: MC
authors.lastname: Rodriguez-Barradas
authors.forename: Cynthia L
authors.initials: CL
authors.lastname: Gibert
authors.forename: Kris Ann K
authors.initials: KA
authors.lastname: Oursler
authors.forename: Matthew Bidwell
authors.initials: MB
authors.lastname: Goetz
authors.forename: Stephen
authors.initials: S
authors.lastname: Crystal
authors.forename: David A
authors.initials: DA
authors.lastname: Leaf
authors.forename: Adeel A
authors.initials: AA
authors.lastname: Butt
authors.forename: R Scott
authors.initials: RS
authors.lastname: Braithwaite
authors.forename: Robin
authors.initials: R
authors.lastname: Peck
authors.forename: Amy C
authors.initials: AC
authors.lastname: Justice
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D015897:Comorbidity; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000401:mortality*; D018023:HIV Seronegativity; D006679:HIV Seropositivity / Q000188:drug therapy / Q000401:mortality*; D015497:HIV-1 / Q000276:immunology; D006801:Humans; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011788:Quality of Life; D012907:Smoking / Q000009:adverse effects* / Q000453:epidemiology; D016019:Survival Analysis; D014481:United States / Q000453:epidemiology; D014728:Veterans / Q000706:statistics & numerical data*; D019562:Viral Load
chemical_list: D019380:Anti-HIV Agents