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Clin Infect Dis. 2019 Feb 1;68(4):650-657. doi: 10.1093/cid/ciy508.

Cessation of Cigarette Smoking and the Impact on Cancer Incidence in Human Immunodeficiency Virus-infected Persons: The Data Collection on Adverse Events of Anti-HIV Drugs Study.

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Centre for Clinical Research, Epidemiology, Modelling and Evaluation, Institute for Global Health, University College London, United Kingdom.
Centre of Excellence for Health, Immunity and Infections, Department of Infectious Diseases, Section, Rigshospitalet, University of Copenhagen, Denmark.
Kirby Institute, University of New South Wales, Sydney, Australia.
Dipartimento di Scienze della Salute, Clinica di Malattie Infettive e Tropicali, Azienda Ospedaliera-Polo Universitario San Paolo, Milan, Italy.
National Centre for HIV Malignancy, Chelsea and Westminster Hospital, London, United Kingdom.
Centre Hospitalier Universitaire de Bordeaux and Institut National de la Santé et de la Recherche Médicale, Université de Bordeaux, France.
Academic Medical Center, Department of Global Health and Division of Infectious Diseases, University of Amsterdam.
HIV Monitoring Foundation, Amsterdam, The Netherlands.
Division of Infectious Diseases, Saint Pierre University Hospital, Université Libre de Bruxelles, Brussels, Belgium.
Department of Public Health, Nice University Hospital, France.
Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Switzerland.
ICAP-Columbia University and Harlem Hospital, New York, New York.



Cancers are a major source of morbidity and mortality for human immunodeficiency virus (HIV)-infected persons, but the clinical benefits of smoking cessation are unknown.


Participants were followed from 1 January 2004 until first cancer diagnosis, death, or 1 February 2016. Smoking status was defined as ex-smoker, current smoker, and never smoker. Adjusted incidence rate ratios (aIRRs) were calculated using Poisson regression, adjusting for demographic and clinical factors.


In total 35442 persons from the Data Collection on Adverse Events of Anti-HIV Drugs (D:A:D) study contributed 309803 person-years of follow-up. At baseline, 49% were current smokers, 21% were ex-smokers, and 30% had never smoked. Incidence of all cancers combined (n = 2183) was highest <1 year after smoking cessation compared to never smokers (aIRR, 1.66 [95% confidence interval {CI}, 1.37-2.02]) and not significantly different from never smokers 1-1.9 years after cessation. Lung cancer incidence (n = 271) was elevated <1 year after cessation (aIRR, 19.08 [95% CI, 8.10-44.95]) and remained 8-fold higher 5 years after smoking cessation (aIRR, 8.69 [95% CI, 3.40-22.18]). Incidence of other smoking-related cancers (n = 622) was elevated in the first year after cessation (aIRR, 2.06 [95% CI, 1.42-2.99]) and declined to a level similar to nonsmokers thereafter.


Lung cancer incidence in HIV-infected individuals remained elevated >5 years after smoking cessation. Deterring uptake of smoking and smoking cessation efforts should be prioritised to reduce future cancer risk.


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