title: Tobacco Smoking and Tuberculosis among Men Living with HIV in Johannesburg, South Africa: A Case-Control Study.
abstract: METHODS
  Although there is ample evidence that smoking increases the risk of tuberculosis (TB), the magnitude of impact on TB risk among HIV-infected persons is poorly described. Given that a high proportion of patients with TB are co-infected with HIV in South Africa, the risks arising from the intersection of smoking, TB, and HIV/AIDS have key relevance for tobacco control policies.
  
  
  OBJECTIVE
  To evaluate the association of pulmonary tuberculosis (PTB) with current tobacco smoking among men with HIV in South Africa.
  
  
  METHODS
  Case-control study of antiretroviral therapy naïve men with confirmed HIV-infection in Johannesburg. Cases had laboratory-confirmed PTB and controls had no evidence of active TB. Participants were interviewed to collect detailed smoking histories.
  
  
  RESULTS
  We enrolled 146 men diagnosed with PTB and 133 controls. Overall, 33% of participants were currently smoking, defined as smoking a cigarette within 2 months (34% cases vs. 32% controls, p = 0.27). Median CD4 count was lower (60 vs. 81 cells/mm3, P = 0.03) and median viral load was higher (173 vs. 67 copies/ul per thousand, P<0.001) among cases versus controls. In adjusted analyses, current smoking tripled the odds of PTB (aOR 3.2; 95%CI: 1.3-7.9, P = 0.01) and former smoking nearly doubled the odds of PTB (aOR 1.8; 95%CI 0.8-4.4, P = 0.18) compared to never smoking.
  
  
  CONCLUSIONS
  Males with HIV that smoke are at greater odds for developing PTB than non-smokers. Extensive smoking cessation programs are needed to reduce odds of TB and promote health among adults living with HIV.
authors.affiliation: Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America.|Center for Tuberculosis Research, Johns Hopkins School of Medicine, Baltimore, Maryland, United States of America.
authors.forename: Liza
authors.identifier: http://orcid.org/0000-0002-8668-3898
authors.initials: L
authors.lastname: Bronner Murrison
authors.affiliation: Center for Tuberculosis Research, Johns Hopkins School of Medicine, Baltimore, Maryland, United States of America.|Perinatal HIV Research Unit, MRC Soweto Matlosana Collaborating Centre for HIV/AIDS and TB, University of the Witwatersrand, Johannesburg, South Africa.|NRF/DST Center of Excellence for Biomedical TB Research, University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: Neil
authors.initials: N
authors.lastname: Martinson
authors.affiliation: Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America.
authors.forename: Rachael M
authors.initials: RM
authors.lastname: Moloney
authors.affiliation: Perinatal HIV Research Unit, MRC Soweto Matlosana Collaborating Centre for HIV/AIDS and TB, University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: Regina
authors.initials: R
authors.lastname: Msandiwa
authors.affiliation: Perinatal HIV Research Unit, MRC Soweto Matlosana Collaborating Centre for HIV/AIDS and TB, University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: Mondiwana
authors.initials: M
authors.lastname: Mashabela
authors.affiliation: Department of Preventive Medicine, University of Southern California, Los Angeles, California, United States of America.
authors.forename: Jonathan M
authors.initials: JM
authors.lastname: Samet
authors.affiliation: Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America.|Center for Tuberculosis Research, Johns Hopkins School of Medicine, Baltimore, Maryland, United States of America.
authors.forename: Jonathan E
authors.initials: JE
authors.lastname: Golub
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D060085:Coinfection / Q000453:epidemiology*; D015658:HIV Infections / Q000150:complications* / Q000453:epidemiology; D015497:HIV-1; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012307:Risk Factors; D012907:Smoking / Q000453:epidemiology*; D012959:Socioeconomic Factors; D013019:South Africa / Q000453:epidemiology; D011795:Surveys and Questionnaires; D014397:Tuberculosis, Pulmonary / Q000150:complications* / Q000453:epidemiology