Patients with HIV who smoke at greater risk for lung cancer mortality

A new article published in JAMA Internal Medicine projects risk of lung cancer death by smoking status among people living with human immunodeficiency virus (HIV) and receiving care for HIV.

More than 40 percent of people living with HIV in the United States smoke cigarettes, more than double the prevalence in the general population. Among people living with HIV and undergoing antiretroviral therapy, smoking now reduces life expectancy more than HIV. Having HIV and using tobacco may together accelerate the development of lung cancer.

Krishna P. Reddy, M.D., of the Massachusetts General Hospital, Boston, and coauthors estimated cumulative lung cancer death by the age of 80 in people living with HIV by smoking status. They also combined their model-generated estimates with published epidemiological data to project total expected lung cancer deaths among people living with HIV in care in the United States.

Among men, cumulative lung cancer mortality by the age of 80 for heavy, moderate and light smokers who entered HIV care at the age of 40 and continued to smoke was 28.9 percent, 23 percent and 18.8 percent, respectively; for heavy, moderate and light smokers who quit at age 40 it was 7.9 percent, 6.1 percent and 4.3 percent; and for people who never smoked it was 1.6 percent.

Among women, cumulative lung cancer mortality by the age of 80 for heavy, moderate and light smokers who entered HIV care at the age of 40 and continued to smoke was 27.8 percent, 20.9 percent and 16.6 percent, respectively; for heavy, moderate and light smokers who quit at age 40 it was 7.5 percent, 5.2 percent and 3.7 percent; and for people who never smoked it was 1.2 percent.

The study also suggests individuals who were adherent to their antiretroviral therapy but continued to smoke were more likely to die from lung cancer than from traditional AIDS (acquired immune deficiency syndrome)-related causes, depending on smoking intensity and sex.

An estimated 59,900of the 644,2000 people living with HIV and receiving care, who are between the ages of 20 and 64, would be expected to die from lung cancer by age 80 if smoking habits do not change, the authors write.

The study notes limitations due in part to its design as a model-based study.

"Clinicians caring for PLWH [people living with HIV] should offer guideline-based behavioral and pharmacologic treatments for tobacco use. Lung cancer is now a leading cause of death among PLWH but smoking cessation can greatly reduce the risk. Lung cancer prevention, especially through smoking cessation, should be a priority in the comprehensive care of PLWH," the article concludes.