Association of cigarette smoking with HIV prognosis among women in the HAART era: a report from the women's interagency HIV study

Abstract

Objective: We assessed the association of cigarette smoking with the effectiveness of highly active antiretroviral therapy (HAART) among low-income women.

Methods: Data were analyzed from the Women's Interagency HIV Study, a multisite longitudinal study up to 7.9 years for 924 women representing 72% of all women who initiated HAART between July 1, 1995, and September 30, 2003.

Results: When Cox's regression was used after control for age, race, hepatitis C infection, illicit drug use, previous antiretroviral therapy, and previous AIDS, smokers on HAART had poorer viral responses (hazard ratio [HR]=0.79; 95% confidence interval [CI]=0.67, 0.93) and poorer immunologic response (HR=0.85; 95% CI=0.73, 0.99). A greater risk of virologic rebound (HR=1.39; 95% CI=1.06, 1.69) and more frequent immunologic failure (HR=1.52; 95% CI=1.18, 1.96) were also observed among smokers. There was a higher risk of death (HR=1.53; 95% CI=1.08, 2.19) and a higher risk of developing AIDS (HR=1.36; 95% CI=1.07, 1.72) but no significant difference between smokers and nonsmokers in the risk of death due to AIDS.

Conclusions: Some of the benefits provided by HAART are negated in cigarette smokers.

FIGURE 1—

Trends in CD4+ lymphocyte counts (a) and log of viral load (b), by smoking status before highly active antiretroviral therapy initiation.

FIGURE 1—

Trends in CD4+ lymphocyte counts (a) and log of viral load (b), by smoking status before highly active antiretroviral therapy initiation.

FIGURE 2—

Cumulative percentage remaining free from an AIDS-defining condition (a) and surviving (b), by smoking status before highly active antiretroviral therapy initiation.

FIGURE 2—

Cumulative percentage remaining free from an AIDS-defining condition (a) and surviving (b), by smoking status before highly active antiretroviral therapy initiation.