|Year : 2005 | Volume
| Issue : 3 | Page : 75-76
Smoking and HIV Infection
Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh., India
S K Jindal
Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh.
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Jindal S K. Smoking and HIV Infection. Lung India 2005;22:75-6
Smoking remains the most important cause of preventable death and disability. In half a century, it has been identified as the single most identifiable risk factor for chronic obstructive lung disease (COPD), ischaemic heart disease, lung cancer, and several other cancers. Subsequently, it was shown to adversely affect the control of asthma, cause pulmonary function impairment and increase the mortality from tuberculosis. It also predisposes smokers as well as children exposed to environmental tobacco from smokers to respiratory infections. Now, in the last few years, significant evidence has accumulated that smoking increases mortality and morbidity in patients infected with human immuno-deficiency virus (HIV). These observations provide some important food for thought for all those who are engaged and involved in national programmes to control HIV infection. There is one more factor which needs to be handled while treating HIV infection and acquired immuno-deficiency syndrome (AIDS).
Improved strategies for diagnosis and management of HIV disease and complicating infections along with the availability of highly active anti-retroviral therapy (HAART) have significantly improved the prognosis and survival of patients with HIV infection. Any comorbidity which is likely to affect the prognosis is of great concern. While many different organ system are adversely affected by smoking and HIV infection together, I shall like to focus on pulmonary diseases in this note.
In a review of 964 deaths occurring in 185 participating wards of French Hospitals, smoking was recorded in 72% of cancer related deaths  . Lung cancer is now known as an important cause of death in patients with HIV infection who smoke  . Lung cancer is shown to occur at young age in HIV infected smokers and poorly responds to therapy  . Lung cancer in HIV infected women is strongly associated with tobacco use, is twice more common and several-fold above what is expected when matched for age and race  . Prognosis is rather poor and the median survival has ranged from 1.8 months to 14 months which is much shorter than for non HIV infected patients. HIV infected women who smoke have also got a higher risk of cervical cancer. Smoking associated with a higher prevalence of human papilloma virus (HPV) infection in these women, was shown to alter the natural history of HPV infection and the risk of cervical cancer  .
One of the most critical problem in HIV positive individuals is the occurrence of pneumonias and several other infections. A variety of bacteria including the mycobacteria, viruses, fungi and parasites are known to infect these patients. Many of these infections are considered as AIDS defining illnesses. Cigarette smoking, along with injection drug use, sinusitis and COPD is now recognized as an important risk factor in these patients. In a study of 521 HIV infected subjects, tobacco use was shown to significantly increase the risk of pulmonary diseases, particularly community acquired pneumonias and pneumocystis carinii pneumonia  .
Smoking in HIV infected patients results in an accelerated form of emphysema. There was a significantly more prevalence of emphysema detected by high resolution CT scan of the chest. In fact HIV seropositive individuals are at increased risk for the development of respiratory symptoms such as cough, sputum production, wheezing and dyspnoea, even prior to the onset of AIDS-related pulmonary complications  .While some of the effects of smoking could be additional to those of HIV infection, the two are now shown to act 'synergistically' as well. Smoking is shown to inhibit both immunological and non-immunological beneficial lung defences. Many similar effects due to the HIV infection may therefore add insult to the injury. The awareness of this relationship adds greater weight to the arguments against tobacco smoking. An aggressive approach to tobacco cessation is needed especially in this susceptible population  .
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