Lung Cancer High in HIV Patients Who Smoke Regardless of ART Adherence

HealthDay News — For people living with HIV (PLWH), the expected burden of lung cancer is high, if smoking habits do not change, according to a study published in JAMA Internal Medicine.

Krishna P. Reddy, MD, from Massachusetts General Hospital in Boston, and colleagues projected cumulative lung cancer mortality by smoking exposure among PLWH in care. Mortality rates attributed to lung cancer and other non-AIDS-related causes were stratified by smoking exposure, accounting for an HIV-conferred independent risk of lung cancer.

The researchers found that among 40-year-old men with HIV, the estimated cumulative lung cancer mortality was 28.9%, 23.0%, and 18.8%, respectively, for heavy, moderate, and light smokers who continued to smoke; compared with 7.9%, 6.1%, and 4.3%, respectively, for those who quit smoking at age 40 years, and 1.6% for never smokers. 

For women, the corresponding mortality was 27.8%, 20.9%, and 16.6% for current smokers; 7.5%, 5.2%, and 3.7% for former smokers; and 1.2% for never smokers. Individuals who were adherent to antiretroviral therapy (ART) who continued to smoke were 6 to 13 times more likely to die from lung cancer than from traditional AIDS-related causes, with variation by sex and smoking intensity. Individuals with incomplete ART adherence had higher overall mortality due to greater AIDS-related mortality risks, but lower lung cancer mortality. If smoking habits do not change, 9.3% of the approximately 644,200 PLWH aged 20 to 64 years in care in the United States are expected to die from lung cancer.

“Those PLWH who adhere to ART but smoke are substantially more likely to die from lung cancer than from AIDS-related causes,” the authors write.

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Reddy KP, Kong CY, Hyle EP, et al. Lung cancer mortality associated with smoking and smoking cessation among people living with HIV in the United States. JAMA Intern Med. 2017;177(11):1613–1621.