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Smoking, Tobacco Use and HIV

March 2012

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We now know that smoking and using smokeless tobacco products like dip, snuff, or chew can seriously harm your health. We also know that quitting smoking or other tobacco products can stop, and in some cases reverse, these harmful effects.

While quitting smoking or smokeless tobacco is not easy, it is often the single biggest thing you can do to improve your health. You can do it -- and there are many resources available to help you.

Smoking, Tobacco Use, and HIV

Cigarette smoking is a dangerous habit even for those in perfect health. However, the risks involved with smoking seem to be greater for those living with HIV (HIV+). Unfortunately, studies show that HIV+ people are much more likely to smoke than those who are HIV-negative. In years past, many people living with HIV did not worry about the serious illnesses that smoking might cause because they did not expect to be alive long enough to get them. Now that HIV+ people are living longer, healthier lives, it is important to pay attention to issues that affect their long-term health.

Smoking cigarettes may affect HIV in several ways:

  • Less successful HIV drug therapy: researchers think smoking may cause HIV drugs not to work as well as they should
  • More likely to experience side effects of HIV drugs
  • Lower CD4 counts
  • Greater chance of developing opportunistic infections (OIs)
  • Higher rates of HIV transmission: damage to blood vessels caused by smoking can create tiny cuts in the mouth, making it easier for the smoker to get HIV from another person

The Bad News: How Smoking and Tobacco Use Can Hurt Your Health


All forms of tobacco are harmful and addictive. This includes cigarettes, pipes, and cigars as well as smokeless tobacco products such as snuff and chewing tobacco (also known as chew or dip). Smoking affects every system in the body. Some of tobacco's harmful effects are caused by nicotine, the addictive substance in tobacco, while others are caused by any of the 250 toxic chemicals in tobacco smoke. In the short run, smoking raises your blood pressure and heart rate. However, most of the serious negative effects of smoking take years to develop and most commonly include cancer, heart disease, and lung problems.

Smoking and Heart Disease

Smoking is very bad for your heart. Smoking causes your blood vessels to constrict, or get smaller. This reduces oxygen flow to the rest of your body, raises your blood pressure, and makes your heart work harder.

Many HIV+ people have high levels of lipids (fats or fat-like substances) such as cholesterol and/or triglycerides in their blood because of HIV disease and certain HIV drugs (see our info sheet on hyperlipidemia). If you have too much cholesterol in your blood it can build up in your arteries, forming plaque.

Smoking also makes your blood vessels stickier. These smaller, stickier blood vessels are more likely to get clogged with plaque than healthy blood vessels. Clogged blood vessels can cause a heart attack or stroke.

Smoking uses up your body's levels of vitamins and minerals called antioxidants. These micronutrients are responsible for protecting the body against heart disease and cancer.

Smoking and Cancer

Of the several thousand chemicals in tobacco smoke, at least 69 are known to cause cancer.

Most people know that there is a strong link between cigarette smoking and lung cancer. Lung cancer is very serious and usually fatal. Compared to non-smokers, smoking increases women's risk of lung cancer by 13 times -- and men's by 23 times.

Scientists aren't sure why, but lung cancer is much more common in HIV+ smokers than HIV-negative smokers. It is thought that HIV drugs may play a role in increasing lung cancer risk, or that HIV attacking the immune system may leave the body less able to fight off cancer.

In addition to lung cancer, smokers are also at higher risk for:

  • Cervical cancer
  • Uterine cancer
  • Cancer of the mouth, throat, voice box, and many more

Smoking and Lung Disease

Smoking damages the small air sacs in the lung called alveoli. It is therefore the main cause of chronic obstructive pulmonary disease (COPD), which includes emphysema and chronic bronchitis. Smoking can also make asthma worse, and can increase the risk of respiratory infections. This is especially important for people with low CD4 counts.

Smoking and Opportunistic Infections

The rates of opportunistic infections (OIs) in the HIV+ population have dropped drastically since people began using combinations of HIV drugs. But studies are showing that smokers are more likely to get certain OIs than non-smokers. Smoking has been shown to increase your risk for developing:

  • Pneumocystis pneumonia (PCP)
  • Tuberculosis (TB)
  • Cryptococcal meningitis
  • Thrush
  • Cervical cancer
  • Anal cancer

Smoking and Women

There are additional concerns that women who smoke may face. First of all, smoking increases the likelihood that a woman will have trouble getting pregnant. It also decreases a man's sperm count and leads to abnormally-shaped sperm. If a woman smokes during pregnancy, she increases the chances of miscarriage, prematurity (born too early), having a low birth weight baby, and stillbirth (born dead). Researchers believe that smoking may also increase a woman's chances of giving HIV to her baby during delivery.

Children born to women who smoked during pregnancy or are exposed to smoke in the home (second-hand smoke) are more likely to develop sudden infant death syndrome (SIDS). Children who are around parents who smoke are more likely to suffer from asthma, colds, and ear infections.

Also, smoking is a major risk factor for osteoporosis (bone disease). This is in addition to the risk of bone disease already associated with being HIV+ and being a woman.

Finally, smoking can put a damper on your love life by causing impotence (inability to maintain an erection) in men who smoke or breathe secondhand smoke.

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This article was provided by The Well Project. Visit The Well Project's Web site to learn more about their resources and initiatives for women living with HIV. The Well Project shares its content with to ensure all people have access to the highest quality treatment information available. The Well Project receives no advertising revenue from or the advertisers on this site. No advertiser on this site has any editorial input into The Well Project's content.
See Also
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