Smoking isn't good for anybody, but it's certainly worse for certain patient populations. To determine just how bad smoking is for patients with HIV or AIDS, Danish researchers examined data from the country's comprehensive and well-maintained national health registries. A total of 2,921 patients with HIV were included for analysis; all were receiving treatment at one of Denmark's eight specialized medical centers between 1995 and 2010. Injection drug users were excluded. Between one and four control subjects were matched for sex and birth year to each patient with HIV; 10,642 matched controls were identified.

The HIV group and matched controls were followed for 14,281 and 45,122 patient years, respectively. Almost half of those in the HIV group (47%) were current smokers, compared with 21% in the control group.

Current smokers had the highest mortality rates in both groups. In the HIV group, all-cause mortality was 24% among smokers, compared with 6% among those who never smoked and 13% among patients who smoked previously. Similarly, all-cause mortality in the control group was 6% among current smokers and 1% in those who never smoked.

AIDS-related death was more common among current smokers than among those who never smoked. And HIV-positive smokers were more than five times more likely to experience a non-AIDS-related death than those who never smoked. In particular, the risk of death from cancer or cardiovascular disease was markedly higher in smokers. And patients with HIV lost more years of life to smoking than to HIV.

The authors write that the study results reinforce the importance of counseling patients with HIV on the risks of smoking. They note that their results may not be generalizable to all HIV-positive populations because theirs included only patients receiving regular HIV care and free access to treatment. However, they also state that their ability to examine the entire HIV-positive population in Denmark is one of the major strengths of the study.

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