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Smoking Nearly Triples the Risk of Death

By Alan McCord

February 20, 2009

In a poster presentation at CROI 2009 in Montreal, Canada, results from the five-year FRAM study showed that current smoking, as well as older age, significantly increased the risk of death in people living with HIV. Although the study examined many factors related to disease progression and death, the one that was most notable was smoking. Smoking contributes to heart and lung disease and cancer, among many other conditions.

It's well documented that HIV-positive people smoke more on average than HIV-negative individuals. Figures point anywhere from 47-70%, while the national average hovers around 20%. This is due to a variety of factors, such as low income levels, black race, drug use and using smoking as a coping mechanism. However, it's a habit that a person has some control over, especially with the support of smoking cessation programs, health professionals, friends and family.. This makes this finding an important one for people with HIV and their health providers.

FRAM (Fat Redistribution and Metabolic Change in HIV infection) followed 922 men and women living with HIV along with 278 HIV-negative individuals. The study compared the association of HIV infection with death after adjusting for demographics such as age, sex and gender, and risks for heart disease (cardiovascular risk factors such as diabetes, smoking, hypertension and lipid levels), along with HIV-related risk factors.

After 5 years, within the HIV-positive group, three factors stood out as being independently related to death. These included:

  1. a nearly three-fold risk of death from smoking-related causes (273%),
  2. a 60% increased risk of death for every 10 years of age, and
  3. an increased risk at lower CD4 counts.

Though aging is not something that one can change, a person may be able to influence higher CD4 counts by making informed decisions about effective regimens that better control HIV disease, along with being more diligent about their health. Smoking habits can be changed through a variety of programs with which health providers can assist.

In another study at CROI, from a Rhode Island stop smoking program in people with HIV, data showed that frequent contact with a stop smoking program and a resolve to quit are more likely to lead someone to quit. Health providers referred individuals to the study. None were required to set a quit date, and all were currently smoking 5 or more cigarettes a day.

Average age was 42, 63% were men and 52% were white. A total of 444 volunteers were randomly assigned to get 2 brief interventions (212) or 4 longer motivational sessions (232) during the 6 months of follow-up. Anyone setting a quit date received nicotine patches.

Although the results were somewhat discouraging, as many stop smoking programs can be, several factors predicted an individual to quit. These included being Hispanic (which may point to a supportive network that encourages the quitting), a high motivation to quit, the use of nicotine patches, and brief and frequent visits focused on using the patches by a program representative.

While not evaluated specifically for people living with HIV, the American Lung Association has a free online smoking cessation program ( with supportive web-based discussion groups. Many communities have free or low cost programs to support people who are stopping smoking, including hospital affiliated programs and volunteer-driving programs like Nicotine Anonymous.

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