Smoking May Shorten Life More Than 6 Years in U.S. Men and Women With HIV

May 5, 2017

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What the Results Mean for You

Before this study we knew that 4 in 10 HIV-positive adults in the United States smoke and that smoking has a tremendous (but reversible) impact on the heart and lungs and on cancer risk. By plugging recorded health findings into mathematical formulas, this study expands the understanding of how smoking affects length of life in people with HIV.

HIV-positive people are living much longer because antiretroviral therapy prevents AIDS diseases and other diseases. The new study estimated that a 40-year-old smoker starting HIV care can expect to live to age 65.2 (men) or 68.1 (women) (Figure 1). But if those smokers quit when they start HIV care at age 40, they can expect to live to age 70.9 (men) or age 72.7 (women). And if people starting HIV care at age 40 never smoked, they can expect to live to age 71.9 (men) or 74.4 (women). In other words, never smoking or quitting smoking may add 5 to 7 years to an HIV-positive person's life (Figure 1) and even more years to the life of someone with perfect pill-taking and appointment keeping.

Confirming earlier findings in Europe and the United States,5 the new mathematical modeling study1 estimated that HIV-positive people may lose more years of life from smoking than from HIV itself. But even middle-aged or older HIV-positive adults can reverse the impact of smoking on life years lost if they stop smoking. This study focused mainly on smokers who stop smoking when they start HIV care at age 40. But HIV-positive smokers who took 5 or 10 years to quit after starting care at age 40 also gained life years. And smokers who started HIV care at age 50, 55, or even 60 added life years if they stopped smoking.

The researchers who conducted this study figured that stopping smoking at age 40 saved more months of life in HIV-positive men (68 months) and women (55 months) than starting antiretroviral therapy at a CD4 count below 500 versus below 200 (48 months). In the general U.S. population, new therapies that cure hepatitis C virus (HCV) infection add an estimated 34 months of life and chemotherapy for metastatic (spreading) lung cancer adds an estimated 7 months.


Quitting smoking is not easy, but it can be done and there are ways to improve chances of success. Smokers should realize three things about quitting:

  1. Among all HIV-positive people in the United States today, 1 in 5 are people who quit smoking.4
  2. Among all people in the United States today, there are more people who quit smoking than still smoke.6
  3. Most people who quit smoking fail to quit several times before they succeed. So if you tried to quit and didn't succeed, keep trying.

Your HIV provider can prescribe nicotine replacement therapy or two drugs -- Chantix or Zyban -- to help you stop smoking. Some smokers who want to quit get good results from a limited number of counseling sessions. You may want to try a free 8-segment online smoke-ending program created for people with HIV at The important thing is to make a plan with your HIV provider or with a smoking counselor your provider recommends and then keep trying until you quit.* If you succeed, you will live longer.

* An online publication from the Center for AIDS has a great deal of practical information on quitting. See pages 9-23 at


  1. Reddy KR, Parker RA, Losina E, et al. Impact of cigarette smoking and smoking cessation on life expectancy among people with HIV: a U.S.-based modeling study. J Infect Dis. 2016;214:1672-1681.
  2. Centers for Disease Control and Prevention, Office on Smoking and Health. Smoking and tobacco use: fast facts.
  3. Jha P, Ramasundarahettige C, Landsman V, et al. 21st-century hazards of smoking and benefits of cessation in the United States. N Engl J Med. 2013;368:341-350.
  4. Mdodo R, Frazier EL, Dube SR, et al. Cigarette smoking prevalence among adults with HIV compared with the general adult population in the United States: cross-sectional surveys. Ann Intern Med. 2015;162:335-344.
  5. Helleberg M, May MT, Ingle SM, et al. Smoking and life expectancy among HIV-infected individuals on antiretroviral therapy in Europe and North America. AIDS. 2015;29:221-229.
  6. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health. The Health Consequences of Smoking -- 50 Years of Progress: A Report of the Surgeon General. 2014.
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This article was provided by The Center for AIDS Information & Advocacy. It is a part of the publication HIV Treatment ALERTS!. Visit CFA's website to find out more about their activities and publications.

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