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J Infect Dis. 2016 Dec 1;214(11):1672-1681. Epub 2016 Nov 3.

Impact of Cigarette Smoking and Smoking Cessation on Life Expectancy Among People With HIV: A US-Based Modeling Study.

Reddy KP1,2,3, Parker RA1,4,5,3, Losina E1,3,6,7, Baggett TP4,3,8, Paltiel AD9, Rigotti NA4,10,11,3, Weinstein MC12, Freedberg KA1,4,13,3,14,12, Walensky RP1,4,13,3,15.

Author information

  • 1Medical Practice Evaluation Center.
  • 2Division of Pulmonary and Critical Care Medicine.
  • 3Harvard Medical School.
  • 4Division of General Internal Medicine.
  • 5Biostatistics Center.
  • 6Department of Orthopedic Surgery.
  • 7Department of Biostatistics.
  • 8Boston Health Care for the Homeless Program.
  • 9Yale School of Public Health, New Haven, Connecticut.
  • 10Tobacco Research and Treatment Center.
  • 11Mongan Institute for Health Policy.
  • 12Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, Boston, Massachusetts.
  • 13Division of Infectious Diseases, Massachusetts General Hospital.
  • 14Department of Epidemiology, Boston University School of Public Health.
  • 15Division of Infectious Diseases, Brigham and Women's Hospital.



 In the United States, >40% of people infected with human immunodeficiency virus (HIV) smoke cigarettes.


 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.


 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.


 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.


HIV; United States; life expectancy; mathematical model; smoking; smoking cessation; tobacco

[Available on 2017-12-01]
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