Smoking-Related Health Risks Among Persons With HIV in the Strategies for Management of Antiretroviral Therapy Clinical Trial

Smoking prevalence is higher among HIV-positive persons than among the general population. In the current study, the researchers sought to determine smoking-related hazard ratios (HRs) and population-attributable risk (PAR) percentage for serious clinical events and death among HIV-positive persons.

For 5,472 HIV-positive persons enrolled from 33 countries in the Strategies for Management of Antiretroviral Therapy (SMART) clinical trial, the team evaluated the relationship between baseline smoking status, development of AIDS-related or serious non-AIDS events, and overall mortality.

Among participants, 40.5 percent were current smokers and 24.8 percent were former smokers. Compared to never smokers, adjusted HRs for current smokers were higher for overall mortality (2.4; P<.001), major cardiovascular disease (2.0; P=.002), non-AIDS cancer (1.8; P=.008) and bacterial pneumonia (2.3; P<.001). Compared to former smokers, current smokers also had higher adjusted HRs for these outcomes.

"The PAR percentage for current versus former and never smokers combined was 24.3 percent for overall mortality, 25.3 percent for major cardiovascular disease, 30.6 percent for non-AIDS cancer, and 25.4 percent for bacterial pneumonia," the authors concluded. "Smoking contributes to substantial morbidity and mortality in this HIV-infected population. Providers should routinely integrate smoking cessation programs into HIV health care."