People living with HIV who adhere to antiretroviral therapy but smoke cigarettes are around 10 times more likely to die of lung cancer than of HIV itself, according to a new study led by Harvard Medical School researchers.
The report, published in JAMA Internal Medicine, suggests that lung cancer prevention through smoking cessation should be a priority in the care of people living with HIV.
“Smoking and HIV are a particularly bad combination when it comes to lung cancer,” said Krishna Reddy, HMS instructor in medicine at Massachusetts General Hospital, who led the study.
“Smoking rates are extraordinarily high among people with HIV, and both smoking and HIV increase the risk of lung cancer,” she added.
People with HIV are now living longer thanks to antiviral medications, but smoking and HIV together put them at higher risk of developing lung cancer than smokers not infected with HIV.
“Lung cancer is now one of the leading killers of people with HIV, but most of these deaths can be prevented,” said Rochelle Walensky, HMS professor of medicine at Mass General and senior author of the study.
Using a computer simulation model of HIV, the researchers estimated the risk of lung cancer among people living with HIV in the U.S. based on whether they are current, former or never smokers, how many cigarettes per day they smoke, or smoked, in the case of former smokers, and whether they consistently take antiviral medications. They also accounted for the risks of other diseases, like heart disease, that are increased by smoking.
The researchers found that nearly 25 percent of these patients who adhere well to anti-HIV medications but continue to smoke will die of lung cancer. Among smokers with HIV who quit at age 40, only about 6 percent will die of lung cancer.
The authors also found that people with HIV who take antiviral medicines but who also smoke are from 6 to 13 times more likely to die of lung cancer than of HIV/AIDS, depending on how much they smoke and and their gender.
Heavy smokers are at even higher risk for lung cancer, with risks of lung cancer death approaching 30 percent. When the researchers focused on people who do not strictly follow recommended HIV treatment, and are thus at greater risk of dying of HIV/AIDS, lung cancer was still estimated to kill more than 15 percent of smokers.
“Quitting smoking is one of the most important things that people with HIV can do to improve their health and live longer. Quitting will not only reduce their risk of lung cancer but also decrease their risk of many other diseases, such as heart attack, stroke and emphysema,” said Travis Baggett, HMS assistant professor of medicine at Mass General and co-author of the study.
More than 40 percent of people living with HIV in the U.S. smoke, compared with 15 percent of the general adult population. Given how common smoking is, the researchers also projected the total number of expected deaths from lung cancer among people currently receiving HIV care in the U.S., taking into account current smoking rates and the imperfect adherence to antiviral therapy that is frequently seen.
They found that nearly 60,000 will die of lung cancer—about 10 percent of all people who are receiving HIV care in the U.S., including both smokers and nonsmokers.
“These data tell us that now is the time for action. Smoking cessation programs should be integrated into HIV care, just like antiviral therapy,” Reddy said.
The study was funded by National Institutes of Health grants K01 DA042687, K23 DA034008, R01 DA015612, T32 HL116275, K01 HL123349, U01 CA199284, R01 MH105203, R01 AI042006 and R37 AI093269, and the Steve and Deborah Gorlin MGH Research Scholars Award.
Lung Cancer and Smoking
Lung cancer is the leading cancer killer of American men and women. Not all people who get lung cancer are smokers, but many people who smoke do get lung cancer. In fact, smoking is directly responsible for more than 80% of lung cancer deaths.
You may be familiar with some of the statistics, but if you, a co-worker, friend, or loved one is a smoker, it’s worth taking another look at what cigarettes can do to our bodies.
Cigarette smoke contains over 7,000 chemicals, including more than 70 that can cause cancer.3 Smoking can cause cancer almost anywhere in your body, including the esophagus, larynx, mouth, nose, throat, trachea, kidney, bladder, pancreas, stomach, cervix, bone marrow, and blood.
And, despite major progress over the past half-century, tobacco use continues to be the leading cause of preventable death and disease in the United States.
More than 160,000 people die each year from cancers caused by cigarette smoking.
Secondhand smoke causes more than 7,000 lung cancer deaths each year.
The statistics around young people are even more sobering. Each day in the United States:
- Nearly 2,300 youth under 18 years of age smoke their first cigarette.
- Nearly 400 youth under 18 years of age become daily cigarette smokers.
The good news is that you can do something about it now.
Ways to Reduce Your Risk of Lung Cancer
You, your friends, and family can get engaged in the following ways:
- Find a quitting method that works for you
- Educate yourself with the latest information on the health effects of tobacco use