Smoking-related health risks among persons with HIV in the Strategies for Management of Antiretroviral Therapy clinical trial.
OBJECTIVE
We sought to determine smoking-related hazard ratios (HRs) and population-attributable risk percentage (PAR%) for serious clinical events and death among HIV-positive persons, whose smoking prevalence is higher than in the general population.


METHODS
For 5472 HIV-infected persons enrolled from 33 countries in the Strategies for Management of Antiretroviral Therapy clinical trial, we evaluated the relationship between baseline smoking status and development of AIDS-related or serious non-AIDS events and overall mortality.


RESULTS
Among all participants, 40.5% were current smokers and 24.8% were former smokers. Adjusted HRs were higher for current than for never smokers for overall mortality (2.4; P < .001), major cardiovascular disease (2.0; P = .002), non-AIDS cancer (1.8; P = .008), and bacterial pneumonia (2.3; P < .001). Adjusted HRs also were significantly higher for these outcomes among current than among former smokers. The PAR% for current versus former and never smokers combined was 24.3% for overall mortality, 25.3% for major cardiovascular disease, 30.6% for non-AIDS cancer, and 25.4% for bacterial pneumonia.


CONCLUSIONS
Smoking contributes to substantial morbidity and mortality in this HIV-infected population. Providers should routinely integrate smoking cessation programs into HIV health care.
Lifson
Alan R
AR
Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN 55454-1015, USA. lifso001@umn.edu
Neuhaus
Jacqueline
J
Arribas
Jose Ramon
JR
van den Berg-Wolf
Mary
M
Labriola
Ann M
AM
Read
Timothy R H
TR
D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D002986:Clinical Trials as Topic; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy* / Q000401:mortality*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008175:Lung Neoplasms / Q000209:etiology / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011446:Prospective Studies; D012306:Risk; D012878:Skin Neoplasms / Q000209:etiology / Q000401:mortality; D012907:Smoking / Q000009:adverse effects / Q000401:mortality*