Tobacco use increases risk for pulmonary diseases and weakens response to therapy in patients on HAART
The increased risk of developing lung diseases in cigarette smokers has been well recognised. The association between smoking and the risk of developing pulmonary infections in HIV-1-infected patients, however, has not been established.
Researchers from the Department of Psychiatry and Behavioral Sciences at the University of Miami evaluated the effect of tobacco use on respiratory infections in HIV positive patients on HAART. Twenty-seven cases with lower respiratory infections (15 cases of PCP, 12 cases of TB) were compared with the same number of age, gender, socio-economic and HIV status-matched patients, without history of respiratory diseases. Medical history and physical examinations were obtained every six months. Blood was drawn for CD4 and viral load measurements.
A substantial number of HIV-positive smokers who developed PCP (one-third) had been on highly active retroviral therapy (HAART) for more than six months and prophylaxis had been discontinued.
Multivariate analyses indicated that in HIV-infected people, after controlling for HIV status and antiretrovirals, cigarette smoking doubled the risk for developing PCP (p = 0.01). Multivariate analyses demonstrated that long-term smoking also increased the risk (2 x) of developing tuberculosis (p = 0.04).
Moreover, daily tobacco use seemed to attenuate by 40% the immune and virological response to antiretroviral therapies.
These findings indicate that tobacco use significantly increases the risk of pulmonary diseases in HIV-infected subjects and has a potential deleterious impact on antiretroviral treatment.
Miguez MJ et al. Impact of tobacco use on the development of opportunistic respiratory infections in HIV seropositive patients on antiretroviral therapy. Addict Biol 8(1): 39-43. March 2003.
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