Increased risk of Pneumocystis carinii and community-acquired pneumonia with tobacco use in HIV disease

• Published in: International journal of infectious diseases 2005-07, Vol.9 (4), p.208-217
• Main Authors: Miguez-Burbano, Maria Jose, Ashkin, David, Rodriguez, Allan, Duncan, Robert, Pitchenik, Arthur, Quintero, Noaris, Flores, Monica, Shor-Posner, Gail
• Format: Article
• Language: English
• Subjects: AIDS; Anti-HIV Agents - therapeutic use; Biological and medical sciences; Case-Control Studies; Community-Acquired Infections - etiology; Cross-Sectional Studies; Female; HIV; HIV Infections - complications; HIV Infections - drug therapy; Human mycoses; Human viral diseases; Humans; Infectious diseases; Male; Medical sciences; Mycoses; Mycoses of the respiratory system; PCP; Pneumonia; Pneumonia, Bacterial - etiology; Pneumonia, Pneumocystis - etiology; Risk Factors; Smoking; Substance-Related Disorders; T Lymphocytes; Tobacco Products; Tobacco, tobacco smoking; Toxicology; Tuberculosis; Viral diseases; Viral diseases of the lymphoid tissue and the blood. Aids
• ISSN: 1201-9712; 1878-3511
• DOI: 10.1016/j.ijid.2004.07.010

Tobacco smoking-related diseases continue to be of great health concern for the public, in general, and may be particularly deleterious for immunosuppressed HIV-positive individuals, who exhibit widespread tobacco use. A total of 521 HIV-infected subjects consecutively admitted to Jackson Memorial Hospital between 2001–2002 were enrolled in the study. Research data included a medical history, details of tobacco and illicit drug use and complete computerized hospital information. Blood was drawn to obtain T lymphocyte profiles and viral load levels. Statistical analysis methods included Pearson, Student's t- and Chi-square tests and SAS Proc CATMOD. Tobacco use was prevalent, with 65% of the 521 HIV-positive hospitalized patients being current smokers. Overall, current tobacco users reported smoking an average of 15 ± 13 cigarettes per day for an average of 15 ± 14 years, with 40% smoking more than one pack per day. Pulmonary infections accounted for 49% of the total hospital admissions: 52% bacterial pneumonias, 24% Pneumocystis carinii pneumonia (PCP), 12% non-tuberculous mycobacterial diseases (NTM), 11% tuberculosis and 1% bronchitis. Many of the respiratory patients (46%) had been on highly active antiretroviral therapy (HAART) for over six months and 42% had received PCP and/or NTM prophylaxis. After matching the cases by HAART and CDC stage, the hazardous risk of being hospitalized with a respiratory infection was significantly higher for smokers than non-smokers (95% CI 1.33–2.83; p = 0.003). Respiratory infections were noted in (37%) of the HAART-treated patients, and most (67%) occurred in smokers. CATMOD analyses controlling for HAART, viral load and CD4, indicated that HIV-infected smokers were three times more likely to be hospitalized with PCP and twice as likely to be hospitalized with community-acquired pneumonia than non-smokers, with increased risk related to the number of cigarettes/day in a dose-dependent manner. Tobacco use, which is widespread among HIV-infected subjects, increases the risk of pulmonary diseases, particularly PCP and CAP, two respiratory infections with high prevalence and morbidity risks even in the era of HAART.