Smoking damages the walls of your blood vessels, increases blood pressure and reduces the amount of oxygen being carried in the blood. If your cholesterol levels are also high, this means that your heart must work even harder to pump blood, and you run more risk of narrowing arteries and blood clots, leading to heart attacks and strokes.

If you have lipid increases on combination therapy:

• The single most important thing you can do to reduce your risk of heart disease if you decide to stay on your existing treatment is to stop smoking.

• If you have any risk factors for heart disease:

• The single most important thing you can do to reduce your risk of heart disease if you are about to start combination therapy is to stop smoking.

The benefit of reducing the number of cigarettes you smoke is very small compared with stopping altogether, but may help to make it easier to give up altogether in the future. Reducing to low tar cigarettes is of no benefit. Heart disease is caused by the nicotine, carbon monoxide and other ingredients in cigarette smoke, not tar.

Your GP can prescribe a variety of things to help you stop smoking, and your HIV clinic may also be able to help. Some people fine nicotine replacement therapy (patches or gum) helpful. However, the drug most commonly used to help stop smoking, Zyban, may interact with protease inhibitors or NNRTIs. Zyban, should not be taken with ritonavir, or by people with a history of seizures, or existing heart disease.