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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

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

Abstract

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.

KEYWORDS:

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

PMID:
27815384
PMCID:
PMC5144729
[Available on 2017-12-01]
DOI:
10.1093/infdis/jiw430
[Indexed for MEDLINE]
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