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Smoking Raises Death Risk--and Lung Disease Common--With HIV
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4th IAS Conference on HIV Pathogenesis, Treatment, and Prevention
July 22-25, 2007
Sydney, Australia
Mark Mascolini
A prospective study of HIV-infected people living in Boston and Providence singled out smoking as an independent risk factor for death [1]. A separate chart review of people living with HIV in Newark found a high proportion with obstructive lung disease, but only a handful who had pulmonary function tests [2].
An analysis of the Nutrition for Health Living cohort is Boston and Providence involved 559 HIV-infected adults monitored twice yearly from January 1997 through June 2005 for numerous death risk factors--CD4 count, viral load, AIDS, current antiretroviral use, chronic diarrhea, depression, illicit drug use, smoking status, body mass index, hemoglobin, and cholesterol [1].
The group's age averaged 41 years, 30% were women, and 53% were white. Nearly two thirds had AIDS when they entered the cohort, and two thirds were taking a potent antiretroviral regimen. Median follow-up stretched to 5 years, and fewer than 5% of study participants dropped out of the cohort.
Among five independent predictors of death, smoking upped the odds of dying most. Compared with nonsmokers, current smokers had a 2.5 times higher death risk during follow-up (95% confidence interval [CI] 1.1 to 5.7, P = 0.03). People with a body mass index below 20 kg/m2 ran a 2.3 times higher risk of death (95% CI 1.0 to 5.4, P = 0.05) than people who weighed 20 to 25 kg/m2.
Injecting drugs made death 2.2 times more likely (95% CI 1.2 to 3.9, P = 0.01), and every 10-fold higher viral load independently raised the risk of death 1.6 times (95% CI 1.2 to 2.0, P = 0.001). Every 100-cell higher CD4 count trimmed the death risk 30% (95% CI 0.7 to 0.9, P < 0.001).
The Nutrition for Healthy Living team proposed that "smoking cessation programs may have a beneficial effect on outcomes in HIV infected patients."
A chart review of all adults with HIV seen at a Newark clinic from January 2000 through July 2006 determined that 471 of 1989 people (23.6%) had one of two signals of obstructive lung disease--clinical documentation of lung disease (including chronic obstructive pulmonary disease, asthma, chronic bronchitis, chronic cough, or wheezing), or prescription of a bronchodilator or an inhaled steroid [2].
The study group had a median age of 46 years and 55% were women. They had HIV infection for a median of 10 years, while median CD4 count stood at 345 and viral loads averaged 88,171 copies. The cohort was 81% black and 13% Hispanic.
Of the 471 people with lung problems, 39% had asthma and 44% reported coughing; 23% complained of shortness of breath and 14% of wheezing. Two thirds of these 471 people smoked or used to smoke, 30% injected drugs, and 49% inhaled illegal drugs, including 9% who smoked marijuana. Clinicians prescribed bronchodilators for 84% of these people and inhaled steroids for 27%.
Despite these high rates of lung trouble, only 30 of 471 people (6%) had a pulmonary function test. In those 30 people, 19 (63%) had abnormal pulmonary function suggesting obstructive lung disease, and 73% had decreased diffusion capacity. Only 13 of these 30 people (43%) got referred to a pulmonary specialist.
The Newark investigators suggested that high rates of smoking and compromised lung function in this urban population indicate a need for increased pulmonary diagnostic testing in similar groups with HIV.
References
1. Quach LA, Tang AM, Schmid CH, et al. The role of cigarette smoking on HIV/AIDS mortality. 4th IAS Conference on HIV Pathogenesis, Treatment, and Prevention. July 22-25, 2007. Sydney. Abstract TUPEB096.
2. Kudipudi R, Seiden J, Debra C, et al. Obstructive lung disease in an urban cohort of HIV-1 infected persons. 4th IAS Conference on HIV Pathogenesis, Treatment, and Prevention. July 22-25, 2007. Sydney. Abstract TUPEB097.
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