Smoking and life expectancy among HIV-infected individuals on antiretroviral therapy in Europe and North America

Marie Helleberg, Margaret T May, Suzanne M Ingle, Francois Dabis, Peter Reiss, Gerd Fätkenheuer, Dominique Costagliola, Antonella d'Arminio, Matthias Cavassini, Colette Smith, Amy C Justice, John Gill, Jonathan A C Sterne, Niels Obel

    200 Citations (Scopus)


    BACKGROUND: Cardiovascular disease and non-AIDS malignancies have become major causes of death among HIV-infected individuals. The relative impact of lifestyle and HIV-related factors are debated.

    METHODS: We estimated associations of smoking with mortality more than 1 year after antiretroviral therapy (ART) initiation among HIV-infected individuals enrolled in European and North American cohorts. IDUs were excluded. Causes of death were assigned using standardized procedures. We used abridged life tables to estimate life expectancies. Life-years lost to HIV were estimated by comparison with the French background population.

    RESULTS: Among 17,995 HIV-infected individuals followed for 79,760 person-years, the proportion of smokers was 60%. The mortality rate ratio (MRR) comparing smokers with nonsmokers was 1.94 [95% confidence interval (95% CI) 1.56-2.41]. The MRRs comparing current and previous smokers with never smokers were 1.70 (95% CI 1.23-2.34) and 0.92 (95% CI 0.64-1.34), respectively. Smokers had substantially higher mortality from cardiovascular disease, non-AIDS malignancies than nonsmokers [MRR 6.28 (95% CI 2.19-18.0) and 2.67 (95% CI 1.60-4.46), respectively]. Among 35-year-old HIV-infected men, the loss of life-years associated with smoking and HIV was 7.9 (95% CI 7.1-8.7) and 5.9 (95% CI 4.9-6.9), respectively. The life expectancy of virally suppressed, never-smokers was 43.5 years (95% CI 41.7-45.3), compared with 44.4 years among 35-year-old men in the background population. Excess MRRs/1000 person-years associated with smoking increased from 0.6 (95% CI -1.3 to 2.6) at age 35 to 43.6 (95% CI 37.9-49.3) at age at least 65 years.

    CONCLUSION: Well treated HIV-infected individuals may lose more life years through smoking than through HIV. Excess mortality associated with smoking increases markedly with age. Therefore, increases in smoking-related mortality can be expected as the treated HIV-infected population ages. Interventions for smoking cessation should be prioritized.

    Original languageEnglish
    Issue number2
    Pages (from-to)221-9
    Number of pages9
    Publication statusPublished - 14 Jan 2015


    • Adult
    • Antiretroviral Therapy, Highly Active
    • CD4 Lymphocyte Count
    • Cohort Studies
    • Europe
    • Female
    • HIV Infections
    • Humans
    • Life Expectancy
    • Male
    • Middle Aged
    • North America
    • Smoking


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