Smoking and life expectancy among HIV-infected individuals on antiretroviral therapy in Europe and North America
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Smoking and life expectancy among HIV-infected individuals on antiretroviral therapy in Europe and North America. / 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.
In: AIDS (London, England), Vol. 29, No. 2, 01.2015, p. 221-229.Research output: Contribution to journal › Journal article › Research › peer-review
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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
Y1 - 2015/1
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 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.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.
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 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.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.
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
VL - 29
SP - 221
EP - 229
JO - AIDS
JF - AIDS
SN - 1350-2840
IS - 2
ER -
ID: 156089556