Patients with human immunodeficiency virus (HIV) who smoke have an increased risk of dying from lung cancer compared with AIDS-related complications, according to a study published in JAMA Internal Medicine.

Antiretroviral therapies (ART) have become more effective, shifting the primary causes of morbidity and mortality for patients with HIV from AIDS to non-AIDS related conditions. As approximately 40% of patients with HIV are cigarette smokers, this study investigated the effect smoking plus HIV may have on lung cancer mortality.

For this study, the authors populated a microsimulation model of HIV disease and treatment with standard demographic data and HIV/AIDS epidemiology statistics with stratifications of smoking status (current, former, never) and intensity (heavy, moderate, light), and projected lung cancer mortality for patients with HIV according to exposure to smoking. The primary outcome of this study was lung cancer mortality by age 80 years.

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Results showed that among 40-year-old men with HIV, lung cancer mortality was 28.9% for heavy smokers, 23.0% for moderate smokers, and 18.8% for light current smokers. For patients who quit smoking by age 40 years, the mortality risk was significantly lower at 7.9%, 6.1%, and 4.3% for heavy, moderate, and light smokers, respectively. For never smokers, the risk was 1.6%.

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Among women, the risk of lung cancer mortality for current heavy, moderate, and light smokers was 27.8%, 20.9%, and 16.6%, respectively, and 7.5%, 5.2%, and 3.7% for former smokers, respectively. Never smokers had a 1.2% risk. 

Depending on sex and smoking intensity, patients who adhered to ART therapy were 6 to 13 times more likely to die from lung cancer compared with traditional AIDS-related causes. Patients who were not ART-adherent had higher rates of overall mortality from other AIDS-related complications, but had lower lung cancer mortality.

The authors concluded, “[l]ung cancer prevention, especially through smoking cessation, should be a priority in the comprehensive care of [patients living with HIV].”


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 [published online September 18, 2017]. JAMA Intern Med. doi: 10.1001/jamainternmed.2017.4349