HIV + people and smokers with good ART adherence at higher risk of death from lung cancer than from AIDS-related diseases
People living with HIV, on antiretroviral treatment with fully suppressed viral load, who smoke, are much more likely to die from lung cancer than HIV-related causes, according to the results of a modeling study published today inJAMA Medicin intern.
The study suggests that successful people in antiretroviral treatment are six to thirteen times more likely to die from lung cancer than those with any AIDS-related illness and 10% of all people with HIV who are linked to care will eventually die of lung cancer.
The modeling study lends greater weight to the view that smoking poses a greater threat to the health of people with HIV who are well-controlled than the virus itself.
About 40% of HIV + people and smokers in the United States are estimated to be at risk of death from smoking-related illnesses compared to about 15% of the general population in 2015.
HIV + people and smokers have a reduced life expectancy from cardiovascular disease (stroke and heart attack), cancer and chronic obstructive pulmonary disease (emphysema).
A modeling study by the same research group estimated that in people with HIV with suppressed viral load in treatment, smoking decreases life expectancy in six years.
Using data from recently published studies at the start of antiretroviral treatment in the United States, researchers projected lung cancer mortality up to the age of 80 according to smoking behavior and age at the start of HIV treatment. They also calculated the effects of quitting smoking at different ages on mortality.
The model of the principle that people living with HIV enter into a CD4 cell count of 360 cells / mm3, and that 87% of people who started treatment would achieve viral suppression. The researchers applied risks for the development of lung cancer, derived from the general population in current data and ex-smokers. Smokers were stratified according to heavy (28 to 35 per day), moderate (14 to 18 per day) and light use (2 per day) at the age of 40. The intensity of smoking was assumed to remain unchanged over time. Mortality risks were calculated by sex, age and smoking exposure.
Among men, cumulative lung cancer mortality by age of 80 for heavy, moderate and mild smokers who went into HIV care at the age of forty and continued smoking was 28,9%, 23% and 18,8%, respectively.
Smoking cessation had many substantial benefits for HIV + people and smokers. For heavy, moderate and mild category of smokers in the age of 40 the cumulative mortality of lung cancer was 7,9%, 6,1% and 4,3%; and for people who never smoked it was 1,6%. Men who got into care at age fifty and stopped smoking also had a substantial reduction in mortality (13,5% for heavy smokers, 10.6% for moderate smokers and 7,7% for mild smokers when compared to 1,6% for those who never smoked ).
Among women, cumulative lung cancer mortality by age of 80 for heavy, moderate and mild category of smokers who went into HIV care at the age of forty and continued smoking was 27,8%, 20,9% and 16,6% respectively ; for heavy, moderate and mild category of smokers in the age of 40 was 7,5%, 5,2% and 3,7%; and for women who never smoked it was 1,2%.
The model showed that male smokers who started HIV treatment at age forty and consistently adhered to treatment were ten times more likely to die from lung cancer than an AIDS-associated disease by the age of 80 (23 vs. 2,3% ). When all the causes of mortality were considered, men aged 40 who smoked had 35 times more likely to die from lung cancer or other AIDS-related and 27 women times more likely.
Only under 60.000 people living with HIV are likely to die from lung cancer at 80 years of age (9,3% of all people with HIV currently in care in the United States). The impact of smoking as a cause of death will become increasingly evident in the population of people living with HIV, say the study's authors. Lung cancer is already the leading cause of death among people with HIV in France, where smoking levels are similar to those in the United States.
The study was conducted by Krishna P. Reddy of Massachusetts General Hospital Boston and colleagues.
The study's authors recommend intensifying efforts to help people with HIV stop smoking and stop smoking interventions to become a key component of the care package for people with HIV, including pharmacological treatments.
"Compared with suppressor of HIV replication, can it really be beyond our capabilities to hold the tobacco harms?" Asks Dr Mitchell Katz of the Los Angeles County Health Department in a commentary accompanying the article inJAMA Internal Medicine. He points out that physicians still prescribe nicotine replacement therapies like varenicline and bupropion.
Translated by Cláudio Souza in 22 of September of 2017 of the Original written by keith Alcorn inSmokers with HIV doing well on treatment now at greater risk of lung cancer than AIDSPosted in 19 September 2017.
Revised by Mara T. Macedo in 17 September 2017