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 2.67 (95% CI 1.60–4.46), respectively]. 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.Conclusion: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.

Immunosenescence and hurdles in the clinical management of older HIV-patients

“…These findings were also confirmed by other recent reports. [115][116][117][118][119] In conclusion, while starting HAART in older HIV-infected patients is undoubtedly recommended, the poorer immunological response seen in this population represent a matter of concern and should be intensively investigated to increase life expectancy of elderly patients.…”

Impatto del fumo di sigaretta sulla mortalità a 10 anni in una coorte di pazienti con infezione da HIV.

“…Durante 3097 anni persona di follow-up abbiamo registrato 62 decessi. Lo studio mostra che oltre la metà della popolazione ha il fumo di sigaretta come fattore di rischio, ed essere fumatore ha un impatto significativo sulla mortalità globale in linea con segnalazioni provenienti da altri paesi (8). La mortalità per causa neoplastica e cardiovascolare, come atteso, è ancora maggiormente influenzata dall'essere fumatore.…”

HIV-Associated Gastrointestinal Cancer

“…Tobacco use, 1 of the accepted risk factors for squamous cell carcinoma, is much more prevalent in the HIV-infected compared to the HIV-negative population [11]. Correspondingly, a case series found squamous cell carcinoma to be more frequent in HIV patients [12], although this was not the case for adenocarcinoma.…”

“…Thus, early diagnosis and antiretroviral treatment are crucial to prevent malignancies. Of note, well-treated HIV patients lose more life years through smoking than through HIV [11], a fact that makes preventive measures even more important. Close cooperation between infectious disease specialists, hepatologists, gastroenterologists and oncologists is crucial to ensure optimal prevention, screening and diagnosis of GIT cancer in HIV-infected persons.…”