Impact of Cigarette Smoking and Smoking Cessation on Life Expectancy Among People With HIV: A US-Based Modeling Study.
BACKGROUND
In the United States, >40% of people infected with human immunodeficiency virus (HIV) smoke cigarettes.


METHODS
We used a computer simulation of HIV disease and treatment to project the life expectancy of HIV-infected persons, based on smoking status. We used age- and sex-specific data on mortality, stratified by smoking status. The ratio of the non-AIDS-related mortality risk for current smokers versus that for never smokers was 2.8, and the ratio for former smokers versus never smokers was 1.0-1.8, depending on cessation age. Projected survival was based on smoking status, sex, and initial age. We also estimated the total potential life-years gained if a proportion of the approximately 248 000 HIV-infected US smokers quit smoking.


RESULTS
Men and women entering HIV care at age 40 years (mean CD4+T-cell count, 360 cells/µL) who continued to smoke lost 6.7 years and 6.3 years of life expectancy, respectively, compared with never smokers; those who quit smoking upon entering care regained 5.7 years and 4.6 years, respectively. Factors associated with greater benefits from smoking cessation included younger age, higher initial CD4+T-cell count, and complete adherence to antiretroviral therapy. Smoking cessation by 10%-25% of HIV-infected smokers could save approximately 106 000-265 000 years of life.


CONCLUSIONS
HIV-infected US smokers aged 40 years lose >6 years of life expectancy from smoking, possibly outweighing the loss from HIV infection itself. Smoking cessation should become a priority in HIV treatment programs.
Medical Practice Evaluation Center.|Division of Pulmonary and Critical Care Medicine.|Harvard Medical School.
Krishna P
KP
Reddy
Medical Practice Evaluation Center.|Division of General Internal Medicine.|Biostatistics Center.|Harvard Medical School.
Robert A
RA
Parker
Medical Practice Evaluation Center.|Harvard Medical School.|Department of Orthopedic Surgery.|Department of Biostatistics.
Elena
E
Losina
Division of General Internal Medicine.|Harvard Medical School.|Boston Health Care for the Homeless Program.
Travis P
TP
Baggett
Yale School of Public Health, New Haven, Connecticut.
A David
AD
Paltiel
Division of General Internal Medicine.|Tobacco Research and Treatment Center.|Mongan Institute for Health Policy.|Harvard Medical School.
Nancy A
NA
Rigotti
Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, Boston, Massachusetts.
Milton C
MC
Weinstein
Medical Practice Evaluation Center.|Division of General Internal Medicine.|Division of Infectious Diseases, Massachusetts General Hospital.|Harvard Medical School.|Department of Epidemiology, Boston University School of Public Health.|Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, Boston, Massachusetts.
Kenneth A
KA
Freedberg
Medical Practice Evaluation Center.|Division of General Internal Medicine.|Division of Infectious Diseases, Massachusetts General Hospital.|Harvard Medical School.|Division of Infectious Diseases, Brigham and Women's Hospital.
Rochelle P
RP
Walensky
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003198:Computer Simulation; D005260:Female; D015658:HIV Infections / Q000401:mortality*; D006801:Humans; D008017:Life Expectancy; D008297:Male; D008875:Middle Aged; D012907:Smoking / Q000009:adverse effects*; D016540:Smoking Cessation; D016019:Survival Analysis; D014481:United States
HIV; United States; life expectancy; mathematical model; smoking; smoking cessation; tobacco