Key points
- Smoking is one of the most important causes of illness and death in HIV-positive people.
- For people with HIV who are undetectable, smoking has a much greater impact on life expectancy than HIV.
- HIV-positive smokers have a greater risk of lung cancer and other illnesses than other smokers.
Tobacco is a legal, and widely used, drug. However, smoking is addictive and there is clear evidence that it damages health in many ways. About 6 million adults smoke in the UK. Smoking is the main cause of preventable illness and death in the UK, causing around 74,600 deaths per year.
Tobacco is a legal, and widely used, drug. However, smoking is addictive and there is clear evidence that it damages health in many ways. About 6 million adults smoke in the UK. Smoking is the main cause of preventable illness and death in the UK, causing around 74,600 deaths per year.
Health risks of smoking
Smoking damages your heart and blood circulation, increasing your risk of cardiovascular (heart) disease, high blood pressure, heart attack, and stroke. Smoking can also limit blood supply to the penis, causing erection problems.
Smoking causes around 70% of cases of lung cancer and causes many other types of cancer, including mouth, lip, throat, bladder, kidney, pancreas, stomach, liver and cervix cancer.
Smoking damages the lungs and can cause chronic obstructive pulmonary disease (COPD), bronchitis, emphysema, and pneumonia. It can also worsen or prolong symptoms of asthma and other respiratory conditions.
Smoking can affect fertility and cause pregnancy loss. It also damages your skin, teeth, and sense of smell and taste.
Smoking and HIV
Smoking, in itself, does not make HIV infection worse. The rate at which HIV disease progresses or the number of CD4 cells lost is no greater in smokers than non-smokers. However, there are higher levels of smoking among people with HIV than in the general population, with the accompanying health risks.
Smoking is especially dangerous for people living with HIV. For people taking HIV treatment who have an undetectable viral load, smoking has a much greater impact on life expectancy than HIV infection. Smoking can shorten the life expectancy of a person living with HIV by an average of six years and it doubles the risk of death.
One study showed that smokers with HIV were 82% more likely to have a heart attack than people with HIV who didn’t smoke. The researchers estimated that 37% of all heart attacks in people with HIV in the study would have been prevented by not smoking.
Some anti-HIV drugs can cause increases in blood fats, and this can also contribute to cardiovascular illnesses. So, if you smoke and take certain anti-HIV drugs, your risk might be increased even further.
The risk of pregnancy loss is also much higher for women with HIV who smoke compared to HIV-negative smokers. One study showed that smoking increased the risk of pregnancy loss by three-quarters for pregnant women living with HIV.
People living with HIV lose lung function faster than HIV-negative people, and these declines are faster in people who have ever had a very low CD4 count and people who smoke. People with HIV also have an elevated risk for developing chronic obstructive pulmonary disease (COPD), and the risk is even greater if you smoke.
People living with HIV have a higher risk of lung cancer than HIV-negative people, at a younger age than HIV-negative people, and an increased risk of dying from lung cancer compared to HIV-negative people. Smokers with HIV are more likely to die from lung cancer than AIDS-related causes.
Studies have shown that smoking is the main risk factor for non-AIDS-defining cancers, (such as liver cancer) and that one in four cancer diagnoses among people with HIV would have been prevented by not smoking. Smokers with HIV are 61% more likely to develop any cancer; after excluding lung cancer, smokers are still 36% more likely to develop other cancers. Further, HIV itself is an independent risk factor for smoking-related cancers, and this is especially true for women.
Stopping smoking or cutting down
Cigarettes are addictive because they contain nicotine. Some research shows that people living with HIV metabolise nicotine faster than smokers without HIV, which can make it harder to quit. It’s not clear why this is. It might be because of how anti-HIV drugs interact with nicotine, or it could be that HIV itself affects how your body deals with nicotine[i].
However, many people living with HIV can and do quit smoking successfully.
Stopping smoking will significantly reduce your risk of developing smoking related diseases. Evidence shows that quitting smoking substantially reduces the risk of many types of smoking-related cancers after just a year or more of quitting.
If you don’t think you’ll be able to give up smoking completely at the moment, there is also a benefit to cutting down the number of cigarettes you smoke.
Giving up or cutting down, whatever age you are, can improve your day-to-day health as well as potentially increase your life expectancy. You are most likely to stop smoking and stay stopped if you are motivated.
There are lots of ways to get help with giving up (or cutting down) smoking.
Support services
Talk to your GP (family doctor). Taking part in a ‘stop smoking’ or ‘smoking cessation’ service has been shown to help people to stop smoking, and your GP can refer you to one of these. You can take part in group or one-to-one support services. There are also online support services available, and a telephone helpline (see below for details).
Nicotine replacement therapy
You may find that nicotine replacement therapy can help reduce the craving for cigarettes and make quitting easier. Your GP can prescribe patches, gum, or lozenges which contain nicotine. You can also buy these over the counter. There is no evidence that these interact with anti-HIV drugs.
E-cigarettes and vaping
Electronic cigarettes (e-cigarettes) can also be used as nicotine replacement therapy. E-cigarettes allow you to inhale nicotine without most of the harmful effects of smoking. Using an e-cigarette is known as ‘vaping’.
Evidence shows that e-cigarettes are almost twice as effective as other nicotine replacement therapies and many people have found them helpful for quitting. The long-term effects of using e-cigarettes on your health aren’t fully known yet. However, they are safer than smoking and may be a good option to use while you are giving up, particularly if you have tried other methods without success.
Stop-smoking medications
Your GP can prescribe medication to help you stop smoking, such as varenicline or cytisine.
Both of these drugs are safe for people with HIV to use but, like all drugs, they have side effects of their own. Talk to your doctor about whether they might be suitable for you.
There’s evidence that using a medication like varenicline or cytisine along with another treatment like nicotine replacement is the most effective way to stop smoking.
Antidepressants
The antidepressant drug bupropion (Zyban) can also help you stop smoking. However, it interacts with some anti-HIV drugs, especially ritonavir (Norvir, used to ‘boost’ other anti-HIV drugs) and efavirenz (Sustiva) – these drugs can reduce the level of Zyban in your blood and you may need to increase your dose.
Talk to your HIV doctor if you are thinking about taking bupropion so you can work out the best dose for you. The drug can also cause side effects, including dry mouth, insomnia, headaches, and fits.
Some research shows that in people living with HIV, combining treatment for smoking cessation, anxiety and depression is more effective than treatment for smoking cessation alone.
Lifestyle changes
Giving up smoking is hard. You are most likely to give up if you get expert support. But there are things you can do, alongside this, to help you with it.
Avoiding ‘triggers’ – activities that you associate with smoking – where possible, may help. Exercise can also be helpful. Some people find that alternative therapies such as acupuncture and hypnotherapy help them stop smoking.
Where to go for help and support
Find your nearest NHS Stop Smoking Service from the NHS Smokefree website, or call the Smokefree National Helpline to speak to a trained adviser on 0300 123 1044.
If you try to give up smoking and can’t do it, don’t be put off trying again. It takes lots of people a few attempts before they quit for good. It’s worth speaking to your doctor to see if there is something you can do differently when you try to quit again.