Smoking

If you’re concerned about your health, one of the most important things you can do is to stop (or never start) smoking.

Tobacco is a legal and widely used drug. However, smoking is addictive and it is beyond any doubt that smoking can severely damage health and cause early death. HIV-positive smokers may be more likely to get certain AIDS-defining illnesses if they have a weak immune system, and to be at increased risk of developing the metabolic side-effects caused by some anti-HIV drugs.

Smoking, in itself, does not make HIV infection worse. The rate at which HIV disease progresses, or at which CD4 cells are lost, is no greater in smokers than non-smokers. Anti-HIV medication is just as effective in smokers as non-smokers.

However, there is very good evidence that people with HIV who smoke are more likely to get certain infections and illnesses, particularly those affecting the chest. It’s known that smokers are approximately three times more likely than non-smokers to develop the AIDS-defining pneumonia PCP. Oral thrush, a common complaint in people with HIV, is also more common amongst smokers.

Emphysema, a smoking-related illness, occurs much more commonly in HIV-positive smokers than HIV-negative smokers.

It’s well known that smoking increases the risk of heart disease, high blood pressure and stroke in the general public; smoking has now been established as the single biggest risk factor for heart disease in HIV-positive adults. Furthermore, some anti-HIV drugs can cause increases in blood fats, and this can contribute to cardiovascular illnesses.

It’s well established that smoking increases the risk of lung cancer. Although relatively rare, lung cancer seems to occur more often in people with HIV, even if they are taking anti-HIV drugs and have a well-controlled viral load. In one study, all the HIV-positive people who developed lung cancer were smokers.

Stopping smoking (or not starting in the first place) will significantly reduce your risk of developing heart disease and other cardiovascular illnesses, an important cause of serious illness and death in people with HIV today.

You are most likely to stop smoking and stay stopped if you are motivated. Individual or group therapy has been shown to help motivate people to stop smoking, and your HIV treatment centre may have a therapy group for people who are stopping smoking.

Cigarettes are addictive because they contain nicotine. Many people find that nicotine replacement therapy can help reduce the craving for cigarettes and make quitting easier. Your GP may be able to prescribe patches, gum, or lozenges that contain nicotine, and there is no evidence that these interact with anti-HIV drugs. You can also buy all of them over the counter.

The drug varenicline (Champix) works by reducing your craving for a cigarette and by reducing the effects you feel if you do have a cigarette. It will need to be prescribed by your doctor. It doesn’t interact with any anti-HIV drugs, but can have side-effects, including difficulty sleeping and strange dreams, headaches, nausea, dry mouth, and nausea.

The antidepressant drug bupropion (Zyban) has also been licensed to help people stop smoking. However, it interacts with anti-HIV drugs of both the protease inhibitor and NNRTI classes, leading to an increase in the amount of bupropion in the blood. Make sure you tell your HIV doctor if you are thinking about taking bupropion. The drug can cause side-effects, including dry mouth, difficulty sleeping, anxiety or depression, headaches, nausea and vomiting.

Many people find that alternative therapies, such as acupuncture and hypnotherapy, help them stop smoking. Exercise can also be helpful.

Most NHS trusts offer individual and group support to stop smoking; ask your GP for further information, phone the NHS Stop Smoking Helpline on 0800 022 4 332 (Mon to Fri 9am to 8pm, Sat and Sun 11am to 4pm) or visit the NHS website www.smokefree.nhs.uk.

Quit is a UK charity that helps people who want to stop smoking. Their website is www.quit.org.uk.

In Manchester, the Lesbian and Gay Foundation also offers help with quitting through its Queer as Smoke initiative.

Contact NAM to find out more about the scientific research and information used to produce this section.

This content was checked for accuracy at the time it was written. It may have been superseded by more recent developments. NAM recommends checking whether this is the most current information when making decisions that may affect your health.