Smoking Among People Living with HIV/AIDS


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.


      1. Palella, F.J., Jr., et al., Declining morbidity and mortality among patients with advanced human immunodeficiency virus infection. HIV Outpatient Study Investigators. N Engl J Med, 1998. 338(13): p. 853-60.
      2. Vittinghoff, E., et al., Combination antiretroviral therapy and recent declines in AIDS incidence and mortality. J Infect Dis, 1999. 179(3): p. 717-20.
      3. Nakagawa, F., M. May, and A. Phillips, Life expectancy living with HIV: recent estimates and future implications. Curr Opin Infect Dis, 2013. 26(1): p. 17-25.
      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.
      5. Feldman, J.G., et al., Association of cigarette smoking with HIV prognosis among women in the HAART era: a report from the women's interagency HIV study. Am J Public Health, 2006. 96(6): p. 1060-5.
      6. Mdodo, R., 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(5): p. 335-44.
      7. Miller, C.J., et al., Adjudicated morbidity and mortality outcomes by age among individuals with HIV infection on suppressive antiretroviral therapy. PLoS One, 2014. 9(4): p. e95061.
      8. Lifson, A.R., et al., Smoking-related health risks among persons with HIV in the Strategies for Management of Antiretroviral Therapy clinical trial. Am J Public Health, 2010. 100(10): p. 1896-903.
      9. Royce, R.A. and W. Winkelstein, Jr., HIV infection, cigarette smoking and CD4+ T-lymphocyte counts: preliminary results from the San Francisco Men's Health Study. AIDS, 1990. 4(4): p. 327-33.
      10. Crothers, K., et al., The impact of cigarette smoking on mortality, quality of life, and comorbid illness among HIV-positive veterans. J Gen Intern Med, 2005. 20(12): p. 1142-5.
      11. Miguez-Burbano, M.J., et al., Impact of tobacco use on the development of opportunistic respiratory infections in HIV seropositive patients on antiretroviral therapy. Addict Biol, 2003. 8(1): p. 39-43.
      12. Miguez-Burbano, M.J., et al., Increased risk of Pneumocystis carinii and community-acquired pneumonia with tobacco use in HIV disease. Int J Infect Dis, 2005. 9(4): p. 208-17.
      13. Mamary, E.M., D. Bahrs, and S. Martinez, Cigarette smoking and the desire to quit among individuals living with HIV. AIDS Patient Care STDS, 2002. 16(1): p. 39-42.
      14. Shuter, J., S.L. Bernstein, and A.B. Moadel, Cigarette smoking behaviors and beliefs in persons living with HIV/AIDS. Am J Health Behav, 2012. 36(1): p. 75-85.
      15. Tesoriero, J.M., et al., Smoking among HIV positive New Yorkers: prevalence, frequency, and opportunities for cessation. AIDS Behav, 2010. 14(4): p. 824-35.
      16. Zucchetto, A., et al., Excess mortality for non-AIDS-defining cancers among people with AIDS. Clin Infect Dis, 2010. 51(9): p. 1099-101.
      17. Simard, E.P. and E.A. Engels, Cancer as a cause of death among people with AIDS in the United States. Clin Infect Dis, 2010. 51(8): p. 957-62.
      18. Helleberg, M., et al., Mortality attributable to smoking among HIV-1-infected individuals: a nationwide, population-based cohort study. Clin Infect Dis, 2013. 56(5): p. 727-34.
      19. O'Cleirigh, C., et al., The unique challenges facing HIV-positive patients who smoke cigarettes: HIV viremia, ART adherence, engagement in HIV care, and concurrent substance use. AIDS Behav, 2015. 19(1): p. 178-85.
      20. Pacek, L.R., et al., Current cigarette smoking among HIV-positive current and former drug users: associations with individual and social characteristics. AIDS Behav, 2014. 18(7): p. 1368-77.
      21. Valiathan, R., et al., Tobacco smoking increases immune activation and impairs T-cell function in HIV infected patients on antiretrovirals: a cross-sectional pilot study. PLoS One, 2014. 9(5): p. e97698.
      22. Huttunen, R., T. Heikkinen, and J. Syrjanen, Smoking and the outcome of infection. J Intern Med, 2011. 269(3): p. 258-69.
      23. Arcavi, L. and N.L. Benowitz, Cigarette smoking and infection. Arch Intern Med, 2004. 164(20): p. 2206-16.
      24. Benard, A., et al., Bacterial pneumonia among HIV-infected patients: decreased risk after tobacco smoking cessation. ANRS CO3 Aquitaine Cohort, 2000-2007. PLoS One, 2010. 5(1): p. e8896.
      25. Petoumenos, K., et al., Rates of cardiovascular disease following smoking cessation in patients with HIV infection: results from the D:A:D study(*). HIV Med, 2011. 12(7): p. 412-21.
      26. Riley, E.D., et al., Poverty, unstable housing, and HIV infection among women living in the United States. Curr HIV/AIDS Rep, 2007. 4(4): p. 181-6.
      27. Boarts, J.M., et al., Relationship of race-, sexual orientation-, and HIV-related discrimination with adherence to HIV treatment: a pilot study. J Behav Med, 2008. 31(5): p. 445-51.
      28. Bogart, L.M., et al., HIV-related stigma among people with HIV and their families: a qualitative analysis. AIDS Behav, 2008. 12(2): p. 244-54.
      29. Stanton, C.A., et al., Loneliness in HIV-infected smokers. AIDS Care, 2015. 27(2): p. 268-72.
      30. Reynolds, N.R., J.L. Neidig, and M.E. Wewers, Illness representation and smoking behavior: a focus group study of HIV-positive men. J Assoc Nurses AIDS Care, 2004. 15(4): p. 37-47.
      31. Ledgerwood, D.M. and R. Yskes, Smoking Cessation for People Living With HIV/AIDS: A Literature Review and Synthesis. Nicotine Tob Res, 2016.
      32. Fuster, M., et al., Smoking cessation in HIV patients: rate of success and associated factors. HIV Med, 2009. 10(10): p. 614-9.
      33. Humfleet, G.L., et al., A randomized clinical trial of smoking cessation treatments provided in HIV clinical care settings. Nicotine Tob Res, 2013. 15(8): p. 1436-45.
      34. Fiore, M., et al., Treating tobacco use and dependence: 2008 update. 2008 update ed. Clinical practice guideline. 2008, Rockville, MD: U.S. Department of Health and Human Services. Public Health Service.
      35. Nahvi, S. and N.A. Cooperman, Review: the need for smoking cessation among HIV-positive smokers. AIDS Educ Prev, 2009. 21(3 Suppl): p. 14-27.
      36. Rahmanian, S., et al., Cigarette smoking in the HIV-infected population. Proc Am Thorac Soc, 2011. 8(3): p. 313-9.
      37. Shuter, J., et al., Provider beliefs and practices relating to tobacco use in patients living with HIV/AIDS: a national survey. AIDS Behav, 2012. 16(2): p. 288-94.
      38. Horvath, K.J., et al., Addressing smoking during medical visits: patients with human immunodeficiency virus. Am J Prev Med, 2012. 43(5 Suppl 3): p. S214-21.
      39. Richardson, A., et al., Engagement promotes abstinence in a web-based cessation intervention: cohort study. J Med Internet Res, 2013. 15(1): p. e14.
      40. Moadel, A.B., et al., A randomized controlled trial of a tailored group smoking cessation intervention for HIV-infected smokers. J Acquir Immune Defic Syndr, 2012. 61(2): p. 208-15.
      41. Lloyd-Richardson, E.E., et al., Motivation and patch treatment for HIV+ smokers: a randomized controlled trial. Addiction, 2009. 104(11): p. 1891-900.
      42. Lauder, W., et al., A comparison of health behaviours in lonely and non-lonely populations. Psychol Health Med, 2006. 11(2): p. 233-45.
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