The Added Dangers of Cigarette Smoking in the HIV Positive Patient

We all know that smoking is an unhealthy habit for anyone. Tobacco is an addictive and lethal drug, and there is no doubt that it causes many serious health conditions and even early death. Despite all that we know about the dangers of smoking and all of the warnings that are constantly in the media, tobacco is still a widely used drug. As HIV infected individuals are now living longer, we need to take a serious look at the long term health implications of smoking in this patient population.

I won't try to go into all of the health problems caused by smoking or discuss smoking cessation methods in detail here, but I'll provide some great links at the end of this article to get you all thinking about quitting. My objective today is to get HIV positive people thinking about the increased dangers of health problems associated with the combination of smoking and chronic HIV infection. You can get information regarding medical terms and opportunistic infections at TheBody.com.
The only "good" news is that most studies have shown that smoking, in itself, has not been shown to affect HIV infection itself. Smoking does not affect the rate at which the CD4 cell counts drop or how rapidly HIV progresses to AIDS. Antiretroviral medications used to treat HIV are just as effective in smokers as they are in nonsmokers. If you can even consider this to be "good" news, read on to learn about the specific risks associated with HIV and smoking.

1. Opportunistic Infections and AIDS-defining Illness: Smoking weakens the immune system and interferes with lung functioning. This leads to a decreased ability to fight off infections, making HIV positive smokers more likely to develop certain infections and AIDS-defining illnesses, particularly those related to the lungs (such as PCP pneumonia and MAC). Oral thrush, oral hairy leukoplakia, and bacterial pneumonia also occur much more frequently in HIV positive smokers. In women, smoking can increase the severity of human papilloma virus (HPV), leading to the increased risk of aggressive cervical cancers.
2. Chronic Lung Disease and Emphysema: Smoking causes a constant inflammatory state in all smokers, and this effect is greatly increased in HIV positive smokers. The lung destruction and emphysema that occurs as a result of this chronic inflammation is greatly accelerated in HIV positive smokers; emphysema will develop more frequently, at an earlier age and tends to be more aggressive and disabling.
3. Cancer: Smoking has been strongly linked to many types of cancer, including lung, throat and mouth, bladder, and pancreas. Cancers in general seem to occur more frequently in HIV positive people. Similar to chronic lung disease, these cancers tend to occur at an earlier age and be more aggressive in HIV infected people. This is true even in those who are taking HIV medications and have a well-controlled viral load.
4. Heart Disease: It has been well-established that cigarette smoking is the #1 modifiable risk factor for heart disease. Smoking also increases the risk for high blood pressure and stroke. It is likely that HIV infection itself can increase the risk of heart disease. It is known that certain HIV medications can raise the levels of cholesterol and other fats in your blood, and lower the "good cholesterol", (HDL) and cause certain metabolic changes such as diabetes and high blood sugar, which further increases the risk of heart disease.
5. Liver Disease: Nicotine is a drug, and it needs to be processed by the liver. When combined with the side effects of toxic HIV medications, liver problems may occur, and any pre-existing chronic hepatitis infections may worsen as a result of the stress on the liver. Smoking has also been shown to interfere with the liver's ability to process certain medications properly.
6. Osteoporosis (weak, brittle bones): This can be a result of chronic HIV infection itself or the long-term side effects of HIV medications. Smoking has been shown to increase the risk of osteoporosis in all people. As people are living longer with HIV, the risk of disabling bone fractures impacts on quality of life.

The bottom line is that stopping smoking (or not starting if you are a non-smoker) will greatly improve your health and decrease your risks for many serious health problems.