title: Mortality attributable to smoking among HIV-1-infected individuals: a nationwide, population-based cohort study.
abstract: BACKGROUND
  We assessed mortality attributable to smoking among patients with human immunodeficiency virus (HIV).
  
  
  METHODS
  We estimated mortality rates (MRs), mortality rate ratios (MRRs), life expectancies, life-years lost, and population-attributable risk of death associated with smoking and with HIV among current and nonsmoking individuals from a population-based, nationwide HIV cohort and a cohort of matched HIV-negative individuals.
  
  
  RESULTS
  A total of 2921 HIV patients and 10 642 controls were followed for 14 281 and 45 122 person-years, respectively. All-cause and non-AIDS-related mortality was substantially increased among smoking compared to nonsmoking HIV patients (MRR, 4.4 [95% confidence interval {CI}, 3.0-6.7] and 5.3 [95% CI, 3.2-8.8], respectively). Excess MR per 1000 person-years among current vs nonsmokers was 17.6 (95% CI, 13.3-21.9) for HIV patients and 4.8 (95% CI, 3.2-6.4) for controls. A 35-year-old HIV patient had a median life expectancy of 62.6 years (95% CI, 59.9-64.6) for smokers and 78.4 years (95% CI, 70.8-84.0) for nonsmokers; the numbers of life-years lost in association with smoking and HIV were 12.3 (95% CI, 8.1-16.4) and 5.1 (95% CI, 1.6-8.5). The population-attributable risk of death associated with smoking was 61.5% among HIV patients and 34.2% among controls.
  
  
  CONCLUSIONS
  In a setting where HIV care is well organized and antiretroviral therapy is free of charge, HIV-infected smokers lose more life-years to smoking than to HIV. The excess mortality of smokers is tripled and the population-attributable risk of death associated with smoking is doubled among HIV patients compared to the background population.
authors.affiliation: Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark. mhelleberg@sund.ku.dk
authors.forename: Marie
authors.initials: M
authors.lastname: Helleberg
authors.forename: Shoaib
authors.initials: S
authors.lastname: Afzal
authors.forename: Gitte
authors.initials: G
authors.lastname: Kronborg
authors.forename: Carsten S
authors.initials: CS
authors.lastname: Larsen
authors.forename: Gitte
authors.initials: G
authors.lastname: Pedersen
authors.forename: Court
authors.initials: C
authors.lastname: Pedersen
authors.forename: Jan
authors.initials: J
authors.lastname: Gerstoft
authors.forename: Børge G
authors.initials: BG
authors.lastname: Nordestgaard
authors.forename: Niels
authors.initials: N
authors.lastname: Obel
mesh_terms: D000328:Adult; D002423:Cause of Death; D015331:Cohort Studies; D003718:Denmark / Q000453:epidemiology; D005260:Female; D015658:HIV Infections / Q000401:mortality*; D015497:HIV-1 / Q000472:pathogenicity; D006801:Humans; D053208:Kaplan-Meier Estimate; D008017:Life Expectancy; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012907:Smoking / Q000401:mortality*