One-fifth of all cancers in people living with HIV could have been avoided by not smoking

22 March 2018
A woman smoking a cigarette

Nearly one-fifth (19%) of all cancers among people living with HIV could have been avoided by not smoking according to a recent study among people living with HIV in North America. The study aimed to explore the link between smoking cigarettes and cancer incidence over 15 years.

Data from over 50,000 people in the North American AIDS Cohort Collaboration on Research and Design consortium was reviewed – all of the included participants were living with HIV and all were cancer free at the beginning of the project.

Data revealed that 666 of these people contracted a smoking-related form of cancer and that 50% of those cases could have been avoided by not smoking. Almost all those who developed lung cancer were smokers and researchers attribute an enormous 94% of the lung cancer cases to smoking.

After smoking-related cancers, the two forms of cancer that were most common were Kaposi’s sarcoma and Non-Hodgkin lymphoma, both of which are associated with the advanced stages of HIV infection.

People living with HIV are more likely to be smokers than the general population. In fact, in North America, most people living with HIV are either current or previous smokers. As with all smokers, this puts them at an increased risk of certain cancers, particularly lung cancer. In this study the risk of a smoking-related cancer diagnosis was more than double than among those who had ever smoked than non-smokers and the risk of lung cancer was nearly 18 times as high.

For people living with HIV, there are additional health risks associated with smoking. The researchers point out an inter-relation between HIV, ART adherence and smoking. In the case of lung cancer, smoking weakens the lungs’ immunological defences allowing the HIV to further reduce CD4 cell function. This leads to a lower CD4 count and an increased risk of opportunistic infections.

A different trial, conducted across 33 countries, found that 24% of all deaths in people living with HIV could be attributed to smoking. In addition to various forms of cancer, it observed that 25% of cardiovascular disease and 25% of bacterial pneumonia episodes among people living with HIV were smoking related.

This latest study in North American adds to a body of evidence that smoking reduces the overall life expectancy of people living with HIV – and particularly in the era of effective antiretroviral treatment, where non-communicable diseases increasingly show a greater threat than HIV-related illnesses.

Given this, the researchers suggest that initiatives are needed to support people living with HIV to stop smoking: “These findings provide insight into the considerable cancer burden attributable to cigarette smoking among HIV-infected people and indicate a need for effective smoking cession programs for HIV-infected individuals.”

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Written by Laura Davies