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