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

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. We estimated associations of smoking with mortality more than 1 year after antiretroviral therapy (ART) initiation...

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Veröffentlicht in:AIDS (London) Jg. 29; H. 2; S. 221
Hauptverfasser: Helleberg, Marie, May, Margaret T, Ingle, Suzanne M, Dabis, Francois, Reiss, Peter, Fätkenheuer, Gerd, Costagliola, Dominique, d'Arminio, Antonella, Cavassini, Matthias, Smith, Colette, Justice, Amy C, Gill, John, Sterne, Jonathan A C, Obel, Niels
Format: Journal Article
Sprache:Englisch
Veröffentlicht: England 14.01.2015
Schlagworte:
Adult
Antiretroviral Therapy, Highly Active
CD4 Lymphocyte Count
Cohort Studies
Europe
Female
HIV Infections - drug therapy
HIV Infections - mortality
Humans
Life Expectancy - trends
Male
Middle Aged
North America
Smoking - epidemiology
North America
Europe
ISSN:1473-5571, 1473-5571
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Zusammenfassung: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. 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. 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 3.31 (95% CI 1.80-5.45), respectively]. [corrected]. 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. 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.
Bibliographie:ObjectType-Article-1
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content type line 23
ISSN:1473-5571
1473-5571
DOI:10.1097/QAD.0000000000000540