[pronut-hiv] Cigarette Smoking Blunts Response to HAART

["ProNut-HV" <pronut-hiv@healthnet.org>]

Cigarette Smoking Blunts Response to HAART 

By Martha Kerr

NEW YORK (Reuters Health) Jun 08 - Prognosis is poorer and immunologic failure is more likely in HIV-infected female smokers receiving highly active anti-retroviral therapy (HAART) than nonsmokers on HAART, AIDS investigators report in the June issue of the American Journal of Public Health.

Based on observations that HIV-infected smokers seem to have poorer outcomes than nonsmokers, Dr. Joseph G. Feldman of the State University of New York, Brooklyn, and colleagues analyzed the effect of smoking in participants in the Women's Interagency HIV Study, a multi-site longitudinal study of HIV-infected women enrolled between 1994 and 1995. Mean follow-up was 7.9 years for 994 women on HAART.

"The excess risks for smokers appear to be quite significant," Dr. Feldman reported. Smokers had a poorer viral response than nonsmokers with a hazard ratio (HR) of 0.79, immunologic response was poorer, with a HR=0.85, risk of viral rebound was greater with an HR of 1.39 and immunologic failure was more frequent with an HR of 1.52.

Risk of death was higher with an HR of 1.53 and risk of developing AIDS was greater with an HR of 1.35. There was no difference in deaths from AIDS between smokers and nonsmokers.

"We do not know the exact mechanism whereby smoking diminishes the response to HAART," Dr. Feldman told Reuters Health. "It could well be biological in that cigarette smoke contains thousands of noxious substances and has been found to have a wide array of adverse health effects."

"Smoking could aggravate and further depress an already compromised immune system," Dr. Feldman continued. "It could also be sociological in that smokers are greater risk takers and may not be as compliant in taking medications as non-smokers. We did try to adjust for this by comparing smokers and non-smokers who reported taking their medication at least 95% of the time. The results were the same for compliant smokers and non-smokers."

"Up to now, [smoking cessation] has not been considered a very high priority. If properly informed that smoking might reduce the effectiveness of their medications, HIV-infected people might be motivated to stop smoking even more than smokers in the general population. We simply do not know. Nonetheless, the cost-benefit ratio of smoking cessation programs for these groups would seem to be quite high," Dr. Feldman said.

Am J Public Health 2006;98:1060-1065.

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