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Smoking and life expectancy among HIV-infected individuals on antiretroviral therapy in Europe and North America: The ART Cohort Collaboration
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from Jules: this study suffers from the same limitation of other "HIV/mortality" studies, you can't estimate or project based on limited followup the long term longevity or mortality risk of a younger group of HIV+ because you don't know what will happen to individuals or larger groups as they age past 55-60 years old because this is not a linear line, the affects of comorbidities may set in in a larger way among HIV+ as they age past 55-60 & more as they age past 65. Inflammation may worsen as HIV+ age past 65, as it does in HIV-negs as they age. The affects of cognitive impairment may stat to have a bigger affect in a larger number of patients as they age past, bone fractures may start to increase after this age, and as well CVD & kidney disease, all of these diseases are a higher risk in HIV+ as they get older. Still the risk of smoking is real & will shorten lifespan.
AIDS Nov 25 2014
Helleberg, Marie; May, Margaret T.; Ingle, Suzanne M.; Dabis, Francois; Reiss, Peter; Fatkenheuer, Gerd; Costagliola, Dominique; d'Arminio, Antonella; Cavassini, Matthias; Smith, Colette; Justice, Amy C.; Gill, John; Sterne, Jonathan A.C.; Obel, Nels
Abstract
Background: Cardiovascular disease and non-AIDS malignancies have become major causes of death among HIV-infected individuals. The relative impact of lifestyle and HIV-related factors are debated.
Methods: We estimated associations of smoking with mortality more than 1 year after antiretroviral therapy (ART) initiation among HIV-infected individuals enrolled in European and North American cohorts. IDUs were excluded. Causes of death were assigned using standardized procedures. We used abridged life tables to estimate life expectancies. Life-years lost to HIV were estimated by comparison with the French background population.
Results: Among 17 995 HIV-infected individuals followed for 79 760 person-years, the proportion of smokers was 60%. The mortality rate ratio (MRR) comparing smokers with nonsmokers was 1.94 [95% confidence interval (95% CI) 1.56-2.41]. The MRRs comparing current and previous smokers with never smokers were 1.70 (95% CI 1.23-2.34) and 0.92 (95% CI 0.64-1.34), respectively. Smokers had substantially higher mortality from cardiovascular disease, non-AIDS malignancies than nonsmokers [MRR 6.28 (95% CI 2.19-18.0) and 2.67 (95% CI 1.60-4.46), respectively]. Among 35-year-old HIV-infected men, the loss of life-years associated with smoking and HIV was 7.9 (95% CI 7.1-8.7) and 5.9 (95% CI 4.9-6.9), respectively. The life expectancy of virally suppressed, never-smokers was 43.5 years (95% CI 41.7-45.3), compared with 44.4 years among 35-year-old men in the background population. Excess MRRs/1000 person-years associated with smoking increased from 0.6 (95% CI -1.3 to 2.6) at age 35 to 43.6 (95% CI 37.9-49.3) at age at least 65 years.
Conclusion: Well treated HIV-infected individuals may lose more life years through smoking than through HIV. Excess mortality associated with smoking increases markedly with age. Therefore, increases in smoking-related mortality can be expected as the treated HIV-infected population ages. Interventions for smoking cessation should be prioritized.
Life expectancies and life years lost
Among 35-year-old HIV-infected men, smokers lost 7.9 (95% CI 7.1-8.7) potential life years compared with nonsmokers (Table 4). The life expectancy of 35-year-old HIV-infected men was on average 5.9 (95% CI 4.9-6.9) years shorter than that of 35-year-old men in the background population after adjusting for smoking in the background population. At age 65 years, the loss of life years associated with smokingwas 6.6 (95% CI 6.0-7.2) years, whereas that associated with HIV was only 2.9 (95% CI 2.1-3.7) years. Among 35-year-old HIV-infected individuals with CD4? cell count at least 200 cells/ml or viral load less than 400 copies/ml at baseline, the loss of life years associated with HIV was 3.0 (95% CI 2.0-4.0) and 4.0 (95% CI 2.4-5.6) years, respectively, while that associated with smoking was 5.6 (95% CI 4.8-6.4) and 8.5 (95% CI 6.9-10.1) years.
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