Smoking Among People Living with HIV/AIDS

Summary

More than a million people in the U.S. are living with HIV (human immunodeficiency virus) or AIDS (acquired immunodeficiency syndrome). Thanks to advances in treatment, people living with HIV/AIDS (PLWHA) who use antiretroviral therapy can expect to live as long as people who don’t have HIV. [1-5]

If you are HIV-positive and smoke, you’re not alone. Smoking is much more common among PLWHA than people without HIV.[6]

Stopping smoking can be a challenge, but it’s so important for PLWHA. PLWHA who smoke have nearly twice the risk of dying as PLWHA who don’t smoke.[7] Tobacco use causes one-quarter of deaths among PLWHA today.[8] It also can speed up the progression from HIV to AIDS. [5, 8-12] Quitting will also help you save money and feel good about yourself.

Most PLWHA smokers are interested in quitting.[13-15] The tools and community on BecomeAnEX can make it easier for you and other PLWHA to quit.

Smoking Makes PLWHA Sicker, Faster

Smoking cigarettes can speed up the process of moving from HIV infection to AIDS. Compared to non-smokers, PLWHA who smoke will see:

  • Faster drops in CD4 cell counts[5, 9]
  • Increased risk of pneumonia (both Pneumocystis carinii pneumonia (PCP) and bacterial pneumonia)[8, 10, 11]
  • Twice the risk of developing tuberculosis (for long-term smokers) [11, 12]

HIV weakens your immune system. Because of this, PLWHA are more likely to develop cancers related to viral infection than people without HIV. [16] Smoking increases that risk even further. Of all the cancer-related deaths among PLWHA in the U.S., more than one in five are from lung cancer. [17] One study showed that PLWHA are nearly six times more likely to develop lung cancer than the general population.[16]

Smoking Cancels the Benefits of Anti-Retroviral Therapy

The good news is PLWHA who use antiretroviral therapy (ART) can live as long as people without HIV. The bad news is smoking can erase those advantages. An HIV-positive smoker can lose more life years from smoking than from HIV.[4, 18]

Smoking seems to reduce the effectiveness of ART.[5, 11, 19] Smoking also weakens your immune system.[20-23] As a result, PLWHA using ART who smoke can expect to live an average of 12 years less than non-smokers.[18]

Quitting Smoking When You’re HIV-Positive

When HIV-positive smokers quit, their health improves. PLWHA who quit smoking will see:

  • Lower rates of bacterial pneumonia infection[24]
  • Lower rates of cardiovascular disease[25]
  • An increase in life expectancy[8]

      There are lots of other benefits to quitting smoking, too! Think of all the money you’ll have to spend on other things once you aren’t spending it on cigarettes. You'll also smell fresh, instead of having smoke as your signature scent.

      Quitting is a challenging process for anyone. Many HIV-positive smokers often face challenges that make quitting even harder, such as other substance use, mental health concerns, and loneliness. Feeling anxious or stressed about managing your HIV or the cost of treatment is common. It may also be hard to find quit smoking programs that feel right for you.

      Medication Options

      Medications and support, such as the tools and community found on here on BecomeAnEX, make it easier to quit.[31-33] Using nicotine replacement therapy (NRT) (patches, gum, lozenge, and inhaler) can also double your chances of quitting successfully. [34] There aren’t any known interactions between NRT and ART.[35] The prescription medication varenicline (also known as Chantix) can triple your chances of quitting success. To date, no interactions have been found between varenicline and ART.[35]

      Another prescription medication, bupropion (also known as Wellbutrin), can double quit rates. [34]. HIV providers may use caution when prescribing bupropion to PLWHA who are taking high-dose protease inhibitors.[35, 36] Talk with your health care provider about which quit smoking medication might be right for you.

      Feeling Supported While Quitting

      While many people get support from their health care providers to quit smoking, PLWHA may not. [10] Some HIV care providers don’t feel they have enough time or training to address smoking cessation with their patients. [37] Others don’t feel confident in their ability to help their patients quit. [38]

      The good news is that getting involved in an online community like the one here on EX increases the chances of quitting successfully. [39] For PLWHA, online programs such as BecomeAnEX can help with some of the challenges associated with quitting smoking, particularly feeling lonely or needing support. [40, 41]

      Online communities offer convenient, easy and anonymous support, and information. We’re here 24/7 for as long as you need help quitting smoking.


      References

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      4. Helleberg, M., et al., Smoking and life expectancy among HIV-infected individuals on antiretroviral therapy in Europe and North America. AIDS, 2015. 29(2): p. 221-9.
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