David Wohl, M.D.

You are more likely to convince HIV-infected smokers to use condoms, take HIV meds faithfully and even abstain from their beloved Mountain Dew than do battle with their tobacco addiction. A recently published study from a national cohort of HIV-infected Danes supplies a bunch of new facts that you can use to scare -- er, counsel -- your patients afflicted with tobaccoism:

• Increased risk of dying for an HIV-infected smoker compared to an HIV+ nonsmoker: 4 times
• Life expectancy of a 35 year old HIV-infected patient who smokes: 62 years
• Life expectancy of a 35 year old HIV-infected patient who never smoked: 78 years
• Total years lost due to smoking: 12.3 (!)

The good news? HIV-infected former smokers had mortality rates that were about half that of HIV-infected current smokers. This, plus the prospect of a dozen years of life lost with continued smoking, just may be enough motivation for some to commit to quitting.

But we also must do our part by setting such patients up for success. Facts alone won't do it, and we need to be recommending evidence-based smoking cessation interventions (such as those recommended by the U.S. Centers for Disease Control and Prevention, or those explored by Rafael Laniado-Laborin in a 2010 study). Other than prescribe antiretroviral therapy, it just may be the most life-saving thing we do for our patients.

The Study: Helleberg M, Afzal S, Kronborg G, et al. Mortality Attributable to Smoking Among HIV-1–Infected Individuals: A Nationwide, Population-Based Cohort Study. Clin Infect Dis. 2013; 56(5): 727-734.

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