title: Smoking and life expectancy among HIV-infected individuals on antiretroviral therapy in Europe and North America.
abstract: BACKGROUND
  Cardiovascular disease and non-AIDS malignancies have become major causes of death among HIV-infected individuals. The relative impact of lifestyle and HIV-related factors are debated.
  
  
  METHODS
  We estimated associations of smoking with mortality more than 1 year after antiretroviral therapy (ART) initiation among HIV-infected individuals enrolled in European and North American cohorts. IDUs were excluded. Causes of death were assigned using standardized procedures. We used abridged life tables to estimate life expectancies. Life-years lost to HIV were estimated by comparison with the French background population.
  
  
  RESULTS
  Among 17,995 HIV-infected individuals followed for 79,760 person-years, the proportion of smokers was 60%. The mortality rate ratio (MRR) comparing smokers with nonsmokers was 1.94 [95% confidence interval (95% CI) 1.56-2.41]. The MRRs comparing current and previous smokers with never smokers were 1.70 (95% CI 1.23-2.34) and 0.92 (95% CI 0.64-1.34), respectively. Smokers had substantially higher mortality from cardiovascular disease, non-AIDS malignancies than nonsmokers [MRR 6.28 (95% CI 2.19-18.0) and 3.31 (95% CI 1.80-5.45), respectively]. [corrected]. Among 35-year-old HIV-infected men, the loss of life-years associated with smoking and HIV was 7.9 (95% CI 7.1-8.7) and 5.9 (95% CI 4.9-6.9), respectively. The life expectancy of virally suppressed, never-smokers was 43.5 years (95% CI 41.7-45.3), compared with 44.4 years among 35-year-old men in the background population. Excess MRRs/1000 person-years associated with smoking increased from 0.6 (95% CI -1.3 to 2.6) at age 35 to 43.6 (95% CI 37.9-49.3) at age at least 65 years.
  
  
  CONCLUSIONS
  Well treated HIV-infected individuals may lose more life years through smoking than through HIV. Excess mortality associated with smoking increases markedly with age. Therefore, increases in smoking-related mortality can be expected as the treated HIV-infected population ages. Interventions for smoking cessation should be prioritized.
authors.affiliation: aDepartment of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet bFaculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark cSchool of Social and Community Medicine, University of Bristol, Bristol, UK dUniversité Bordeaux, ISPED, Centre INSERM U897-Epidémiologie-Biostatistique, Bordeaux, France eDepartment of Global Health, Academisch Medisch Centrum bij de Universiteit van Amsterdam, and Stichting HIV Monitoring, Amsterdam, The Netherlands fDepartment of Internal Medicine, University of Cologne and German Centre for Infection Research (DZIF), Cologne, Germany gSorbonne Universités, UPMC Univ Paris 06 hINSERM, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, France iClinic of Infectious Diseases & Tropical Medicine, San Paolo Hospital, University of Milan, Milan, Italy jService des maladies infectieuses, CHUV, Lausanne, Switzerland kResearch Department of Infection and Population Health, University College London, London, UK lYale University, New Haven mVA Connecticut Healthcare System, West Haven, Connecticut, USA nDivision of Infectious Diseases, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Marie
authors.initials: M
authors.lastname: Helleberg
authors.forename: Margaret T
authors.initials: MT
authors.lastname: May
authors.forename: Suzanne M
authors.initials: SM
authors.lastname: Ingle
authors.forename: Francois
authors.initials: F
authors.lastname: Dabis
authors.forename: Peter
authors.initials: P
authors.lastname: Reiss
authors.forename: Gerd
authors.initials: G
authors.lastname: Fätkenheuer
authors.forename: Dominique
authors.initials: D
authors.lastname: Costagliola
authors.forename: Antonella
authors.initials: A
authors.lastname: d'Arminio
authors.forename: Matthias
authors.initials: M
authors.lastname: Cavassini
authors.forename: Colette
authors.initials: C
authors.lastname: Smith
authors.forename: Amy C
authors.initials: AC
authors.lastname: Justice
authors.forename: John
authors.initials: J
authors.lastname: Gill
authors.forename: Jonathan A C
authors.initials: JA
authors.lastname: Sterne
authors.forename: Niels
authors.initials: N
authors.lastname: Obel
mesh_terms: D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D005060:Europe; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000401:mortality*; D006801:Humans; D008017:Life Expectancy / Q000639:trends*; D008297:Male; D008875:Middle Aged; D009656:North America; D012907:Smoking / Q000453:epidemiology*