title: Bacterial pneumonia among HIV-infected patients: decreased risk after tobacco smoking cessation. ANRS CO3 Aquitaine Cohort, 2000-2007.
abstract: BACKGROUND
  Bacterial pneumonia is still a substantial cause of morbidity and mortality in HIV-infected patients in the era of combination Antiretroviral Therapy. The benefit of tobacco withdrawal on the risk of bacterial pneumonia has not been quantified in such populations, exposed to other important risk factors such as HIV-related immunodeficiency. Our objective was to estimate the effect of tobacco smoking withdrawal on the risk of bacterial pneumonia among HIV-infected individuals.
  
  
  RESULTS
  Patients of the ANRS CO3 Aquitaine Cohort with >or= two visits during 2000-2007 and without bacterial pneumonia at the first visit were included. Former smokers were patients who stopped smoking since >or= one year. We used Cox proportional hazards models adjusted on CD4+ lymphocytes (CD4), gender, age, HIV transmission category, antiretroviral therapy, cotrimoxazole prophylaxis, statin treatment, viral load and previous AIDS diagnosis. 135 cases of bacterial pneumonia were reported in 3336 patients, yielding an incidence of 12 per thousand patient-years. The adjusted hazard of bacterial pneumonia was lower in former smokers (Hazard Ratio (HR): 0.48; P = 0.02) and never smokers (HR: 0.50; P = 0.01) compared to current smokers. It was higher in patients with <200 CD4 cells/microL and in those with 200 to 349 CD4 cells/microL (HR: 2.98 and 1.98, respectively; both P<0.01), but not in those with 350 to 499 CD4 cells/microL (HR: 0.93; P = 0.79), compared to those with >or=500 CD4 cells/microL. The interaction between CD4 cell count and tobacco smoking status was not statistically significant.
  
  
  CONCLUSIONS
  Smoking cessation dramatically reduces the risk of bacterial pneumonia, whatever the level of immunodeficiency. Smoking cessation interventions should become a key element of the clinical management of HIV-infected individuals.
authors.affiliation: INSERM, U897, CIC-EC7, Bordeaux, France. antoine.benard@isped.u-bordeaux2.fr
authors.forename: Antoine
authors.initials: A
authors.lastname: Bénard
authors.forename: Patrick
authors.initials: P
authors.lastname: Mercié
authors.forename: Ahmadou
authors.initials: A
authors.lastname: Alioum
authors.forename: Fabrice
authors.initials: F
authors.lastname: Bonnet
authors.forename: Estibaliz
authors.initials: E
authors.lastname: Lazaro
authors.forename: Michel
authors.initials: M
authors.lastname: Dupon
authors.forename: Didier
authors.initials: D
authors.lastname: Neau
authors.forename: François
authors.initials: F
authors.lastname: Dabis
authors.forename: Geneviève
authors.initials: G
authors.lastname: Chêne
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use; D000890:Anti-Infective Agents / Q000008:administration & dosage; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D018410:Pneumonia, Bacterial / Q000150:complications*; D016016:Proportional Hazards Models; D012307:Risk Factors; D016540:Smoking Cessation; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000008:administration & dosage; D019562:Viral Load; D014026:Nicotiana
chemical_list: D019380:Anti-HIV Agents; D000890:Anti-Infective Agents; D015662:Trimethoprim, Sulfamethoxazole Drug Combination