Maryland's Tobacco Resource Center - Linking Professionals to Best Practices

People Living with HIV

Smoking can lead to severe consequences, especially for people living with human immunodeficiency virus (HIV). Approximately 19% of adults in the general population are current smokers[1]. However, these rates are much higher among people living with HIV. Research indicates that among individuals living with HIV, approximately 40% to 66% are current smokers[2-5]. Smoking while HIV-positive has deleterious effects on one’s overall prognosis:

Individuals living with HIV who smoke are more prone to HIV-related opportunistic infections:

·         Long-term smokers (20 years or more) have three times the risk of developing tuberculosis[6].

·         HIV-positive smokers continue to have a heightened risk of developing tuberculosis and Pneumocystis pneumonia, even if they are taking antiretroviral treatments[6].

·         Smoking is associated with the development of Oral candidiasis (a yeast or fungal infection of the mouth) in people living with HIV[7].

Smoking can negatively affect adherence to and effectiveness of antiretroviral treatment:

·         Smoking may reduce response to highly active antiretroviral therapy by 40%[6].

·         Smokers tend to take antiretroviral drugs significantly less frequently than nonsmoking HIV-positive individuals [8]. This is found even after statistically controlling for factors such as substance use history and current depression. This is problematic because not taking antiretroviral drugs as directed may impact one’s ability to successfully manage HIV[8].  

Individuals living with HIV have a compounded risk for smoking-related problems:

·         Smoking significantly increases risk for developing respiratory diseases in individuals living with HIV[6].

·         Chronic Obstructive Pulmonary Disease (COPD) is a common lung disease associated with smoking; HIV appears to be an independent risk factor for the development of COPD among individuals who smoke. In a study of veterans, those who were HIV-positive were 50-60% more likely to develop COPD, independent of factors such as pack-years and age[9].

·         Evidence suggests that risk for lung cancer is greater among people living with AIDS beyond what is expected from smoking[10]. This suggests that smoking and AIDS may have a synergistic effect on the development of lung cancer.

·         HIV is related to the acceleration of the development of emphysema in smokers[11].

·         Individuals living with HIV have an increased risk for developing coronary heart disease[12]. This appears to be related to risk factors associated with HIV, independent of higher smoking rates.

Why change is needed in the future of care for HIV-positive smokers:

·         A recent study found that approximately two-thirds of HIV-positive smokers have taken action in terms of trying to quit and that 74.5% indicated they were interested in quitting[4].

·         Unfortunately, there is a discrepancy between the high interest of quitting among those living with HIV and what is provided by HIV counselors. Only about half of HIV medical providers assess current smokers’ interest in quitting[4].

·         The good news is that progress is within reach. While intensive interventions can have a greater effect on increasing cessation, research suggests that simply giving advice can increase quit rates[13]. Even though this decrease is small, if applied broadly, quit rates can increase a great deal.

·         Smoking cessation can be incorporated into agencies already providing HIV counseling. In fact, when smoking cessation interventions are specifically tailored for people living with HIV, higher quit rates may follow[14, 15]; it appears that interventions can significantly help HIV-positive smokers.

In Summary, smoking is detrimental to one’s general HIV prognosis. Smoking negatively impacts the effectiveness of antiretroviral treatment and adherence to these drugs. Further, smoking has a negative synergetic effect on smoking-related health problems. HIV providers do not typically assess client smoking. However, most individuals with HIV who smoke are interested in quitting and preliminary data show that smoking cessation interventions can and do work for those living with HIV.

Additional Resources:

· Smoking and HIV

·         The AIDS InfoNet Smoking and HIV

·         Veteran Affairs: HIV Provider Smoking Cessation Handbook

·         Veteran Affairs: My Smoking Cessation Workbook: A Resource for Patients

·         Food and Drug Administration: Smoking Cessation 

·         UNAIDS: Terminology Guidelines

·         Center for Disease Control and Prevention (CDC): Tips for Former Smokers Campaign


1. Center for Disease Control and Prevention (2012) Current cigarette smoking among adults - United States, 2011. Morbidity and Mortality Weekly Report, 61, 889-894.

2. Turner, J., Page-Shafer, K., Chin, D., Osmond, D., Mossar, M., Markstein, L., & ... Chesney, M. (2001). Adverse impact of cigarette smoking on dimensions of health-related quality of life in persons with HIV infection. AIDS Patient Care & Stds, 15(12), 615-624.

3. Collins, R., Kanouse, D., Gifford, A., Senterfitt, J., Schuster, M., McCaffrey, D., & ... Wenger, N. (2001). Changes in health-promoting behavior following diagnosis with HIV: prevalence and correlates in a national probability sample. Health Psychology: Official Journal of the Division of Health Psychology, American Psychological Association, 20, 351-360.

4. Tesoriero, J., Gieryic, S., Carrascal, A., & Lavigne, H. (2010). Smoking among HIV positive New Yorkers: prevalence, frequency, and opportunities for cessation. AIDS and Behavior, 14(4), 824-835. doi:10.1007/s10461-008-9449-2

5. Burkhalter, J., Springer, C., Chhabra, R., Ostroff, J., & Rapkin, B. (2005). Tobacco use and readiness to quit smoking in low-income HIV-infected persons. Nicotine & Tobacco Research: Official Journal of the Society for Research on Nicotine and Tobacco, 7, 511-522.

6. Miguez-Burbano, M., Burbano, X., Ashkin, D., Pitchenik, A., Allan, R., Pineda, L., & ... Shor-Posner, G. (2003). Impact of tobacco use on the development of opportunistic respiratory infections in HIV seropositive patients on antiretroviral therapy. Addiction Biology, 8, 39-43.

7. Conley, L. J., Bush, T. J., Buchbinder, S. P., & Penley, K. A. (1996). The association between cigarette smoking and selected HIV- related medical conditions. Aids, 10, 1121-1126. doi:10.1097/00002030-199609000-00010

8. Shuter, J., & Bernstein, S. (2008). Cigarette smoking is an independent predictor of nonadherence in HIV-infected individuals receiving highly active antiretroviral therapy. Nicotine & Tobacco Research: Official Journal of the Society for Research on Nicotine and Tobacco, 10, 731-736. doi:10.1080/14622200801908190

9. Crothers, K., Butt, A., Gibert, C., Rodriguez-Barradas, M., Crystal, S., & Justice, A. (2006). Increased COPD among HIV-positive compared to HIV-negative veterans. Chest130, 1326-1333.

10. Chaturvedi, A. K., Pfeiffer, R. M., Chang, L., Goedert, J. J., Biggar, R. J., & Engels, E. A. (2007). Elevated risk of lung cancer among people with AIDS. AIDS21, 207-213. doi:10.1097/QAD.0b013e3280118fca

11. Diaz, P., King, M., Pacht, E., Wewers, M., Gadek, J., Nagaraja, H., & ... Clanton, T. (2000). Increased susceptibility to pulmonary emphysema among HIV-seropositive smokers. Annals of Internal Medicine, 132, 369-372.

12. Boccara, F., Lang, S., Meuleman, C., Ederhy, S., Mary-Krause, M., Costagliola, D., Capeau, J., & Cohen, A. (2013). HIV and Coronary Heart Disease: Time for a Better Understanding. Journal of the American College of Cardiology (JACC)61, 511-523. doi:10.1016/j.jacc.2012.06.063

13. Stead, L., Buitrago, D., Preciado, N., Sanchez, G., Hartmann-Boyce, J., & Lancaster, T. (2013). Physician advice for smoking cessation. The Cochrane Database of Systematic Reviews, 5CD000165. doi:10.1002/14651858.CD000165.pub4

14. Nahvi, S., & Cooperman, N. (2009). Review: the need for smoking cessation among HIV-positive smokers. AIDS Education and Prevention: Official Publication of the International Society for AIDS Education21(3 Suppl), 14-27. doi:10.1521/aeap.2009.21.3_supp.14

15. Vidrine, D. J., Arduino, R. C., Lazev, A. B., & Gritz, E. R. (2006). A randomized trial of a proactive cellular telephone intervention for smokers living with HIV/AIDS. AIDS (London, England), 20, 253-260.