"What, I have to stop smoking now, too?" I'm sure many of you reading this article feel this way. Most adult smokers are well aware that the decision to smoke comes with very real health risks. If you are living with HIV, there is a growing body of information to suggest you may be at greater risk than your HIV-negative counterparts for developing smoking-related diseases and conditions.

Because of HAART (highly active antiretroviral therapy), people living with HIV are now in the situation of having to evaluate the long-term effects that smoking will have on their overall health. Quality of life has always been a major issue for anyone living with HIV, but historically, we were not concerned with how smoking might affect long term quality of life; now we must be.

Smoking and Emphysema

Contrary to what big tobacco companies have claimed for years, there is a mountain of information to show that smoking can greatly affect the ability of your lungs to work effectively. Emphysema is one condition that is commonly found in people who smoke. Emphysema is the loss of the walls between air sacs in the lungs, resulting in large air pockets, a marked decrease in the ability to oxygenate the blood, and increased lung infections. Some providers have seen emphysema-like lung conditions in people with HIV regardless of whether they smoke or not. These observations led researchers to study the effect of smoking on HIV-positive people, compared to HIV-negative people, matching the two groups for age and other risk factors.

The study found that of the HIV-positive group, 15% were diagnosed with emphysema, compared to only 2% of the HIV-negative group. How much someone smoked also affected their risk of developing emphysema. In this study, 37% of the HIV-positive smokers who smoked the equivalent of one pack a day for 12 years developed emphysema, while none of the HIV-negative smokers, who smoked the same amount, developed emphysema.

Living with emphysema definitely has a negative impact on the long-term quality of life for anyone, and this study suggests that smokers who are also living with HIV are at a greater risk of developing emphysema.

Smoking and Cancer

Again, contrary to what you might have heard from the tobacco industry, there is plenty of information to link smoking to the development of cancer. Recently there has been a steady stream of conversation about what seems like an increased incidence of cancer in people who are on HAART. There has been no evidence to suggest that these cancers are the result of HAART medication, so why does cancer seem to be on the rise among people living with HIV?

If you read the first part of the interview with Dr. Aboulafia in the last issue of the Perspective, you will remember Dr. Aboulafia's story of his client who, even though his HIV viral load was undetectable and he had seen an increase in his CD4 cells, died of pancreatic cancer. This man's past history of heavy smoking more than likely played a causative role in the development of the cancer that led to his death.

As we see more people with HIV developing lung cancer, stomach cancer, or mouth and throat cancer, we must look at the role smoking plays in the development of these life-threatening diseases. Living with HIV can be very challenging, and many times we are faced with medical conditions we have very little control over. That is why it is becoming increasing important to identify areas that we can control, making a huge difference in our overall health

If you decide to stop smoking, but find it difficult to do on your own, please talk to your healthcare provider about the different programs available to you. Working with your provider can help identify the best approach to stop smoking. Some people have had success using nicotine patches or gum, alone. Others have stopped smoking by taking a drug called Zyban® (bupropion, Welbutrin®). If long-term quality of life is your goal, then you must consider the role smoking can play in impacting your health.