Reddy KP, et al. - Researchers illustrated the cumulative lung cancer mortality by smoking exposure among people living with human immunodeficiency virus (HIV) (PLWH) in care. It was determined that the PLWH adhering to antiretroviral therapy (ART) but who smoked exhibited a greater tendency to die from lung cancer than from AIDS-related causes.

Methods

• Standard demographic data and recent HIV/AIDS epidemiology statistics were applied with specific details on smoking exposure, combining smoking status (current, former, or never) and intensity (heavy, moderate, or light), with the aid of a validated microsimulation model of HIV.
• The reported mortality rates attributable to lung cancer and other non-AIDS-related causes were stratified by smoking exposure.
• They were responsible for an HIV-conferred independent risk of lung cancer.
• Lung cancer mortality risk ratios (vs never smokers) for male and female current moderate smokers were discovered to be 23.6 and 24.2, respectively, and for those who quit smoking at age 40 years were 4.3 and 4.5.
• The nonadherence to antiretroviral therapy (ART) and for a range of HIV-conferred risks of death from lung cancer and from other non-AIDS-related diseases (eg, cardiovascular disease) were accounted for, in the sensitivity analyses.
• The main measure consisted of cumulative lung cancer mortality by age 80 years (stratified by sex, age at entry to HIV care, and smoking exposure); total expected lung cancer deaths, accounting for nonadherence to ART.

Results

• The findings reported that the estimated cumulative lung cancer mortality for heavy, moderate, and light smokers who continued to smoke was 28.9%, 23.0%, and 18.8%, respectively; for those who quit smoking at age 40 years, it was 7.9%, 6.1%, and 4.3%; and for never smokers, it was 1.6%, among 40-year-old men with HIV.
• Among women, the corresponding mortality for current smokers was found to be 27.8%, 20.9%, and 16.6%; for former smokers, it was 7.5%, 5.2%, and 3.7%; and for never smokers, it was 1.2%.
• ART-adherent subjects who continued to smoke exhibited 6 to 13 times greater tendency of dying from lung cancer than from traditional AIDS-related causes, based on the sex and smoking intensity.
• Owing to greater AIDS-related mortality risks, those with incomplete ART adherence illustrated higher overall mortality but lower lung cancer mortality.
• Applying model projections to the approximately 644,200 PLWH aged 20 to 64 in care in the United States, death was expected from lung cancer in 59,900 (9.3%) individuals, if smoking habits was not changed.