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

TY - JOUR

T1 - Smoking and life expectancy among HIV-infected individuals on antiretroviral therapy in Europe and North America

AU - Helleberg, Marie

AU - May, Margaret T

AU - Ingle, Suzanne M

AU - Dabis, Francois

AU - Reiss, Peter

AU - Fätkenheuer, Gerd

AU - Costagliola, Dominique

AU - d'Arminio, Antonella

AU - Cavassini, Matthias

AU - Smith, Colette

AU - Justice, Amy C

AU - Gill, John

AU - Sterne, Jonathan A C

AU - Obel, Niels

PY - 2015/1/14

Y1 - 2015/1/14

N2 - 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-relatedmortality can be expected as the treated HIV-infected population ages. Interventions for smoking cessation should be prioritized.

AB - 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-relatedmortality can be expected as the treated HIV-infected population ages. Interventions for smoking cessation should be prioritized.

KW - Adult

KW - Antiretroviral Therapy, Highly Active

KW - CD4 Lymphocyte Count

KW - Cohort Studies

KW - Europe

KW - Female

KW - HIV Infections

KW - Humans

KW - Life Expectancy

KW - Male

KW - Middle Aged

KW - North America

KW - Smoking

U2 - 10.1097/QAD.0000000000000540

DO - 10.1097/QAD.0000000000000540

M3 - Journal article

C2 - 25426809

SN - 0269-9370

VL - 29

SP - 221

EP - 229

JO - AIDS (London, England)

JF - AIDS (London, England)

IS - 2

ER -