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李在村 三甲
李在村 主任医师
北京佑安医院 性病艾滋病临床诊疗中心

吸烟和艾滋病患者的寿命

吸烟影响艾滋病患者的寿命,以前也有研究了。2016年的双十一那天,美国《Journal of Infectious Diseases(感染病杂志)》发表一篇论文,用计算机模型研究得出:与从不吸烟者相比,40岁开始接受艾滋病随访或者治疗、平均CD4计数360的男性和女性艾滋病患者,分别缩短寿命6.7年和6.3年。而开始接受随访或者治疗时戒烟的男性和女性患者,分别可以多活5.7年和4.6年。

不抽烟好吧?戒烟好吧?首都医科大学附属北京佑安医院性病艾滋病临床诊疗中心李在村

Impact of Cigarette Smoking and Smoking Cessation on Life Expectancy Among People With HIV: A US-Based Modeling Study

  1. Krishna P. Reddy1,2,8, 

  2. Robert A. Parker1,3,4,8, 

  3. Elena Losina1,8,9,11,

  4. Travis P. Baggett3,8,13, 

  5. A. David Paltiel15, 

  6. Nancy A. Rigotti3,5,6,8,

  7. Milton C. Weinstein14, 

  8. Kenneth A. Freedberg1,3,7,8,12,14 and

  9. Rochelle P. Walensky1,3,7,8,10

+Author Affiliations

  1. 1Medical Practice Evaluation Center
  2. 2Division of Pulmonary and Critical Care Medicine
  3. 3Division of General Internal Medicine
  4. 4Biostatistics Center
  5. 5Tobacco Research and Treatment Center
  6. 6Mongan Institute for Health Policy
  7. 7Division of Infectious DiseasesMassachusetts General Hospital
  8. 8Harvard Medical School
  9. 9Department of Orthopedic Surgery
  10. 10Division of Infectious DiseasesBrigham and Women's Hospital
  11. 11Department of Biostatistics
  12. 12Department of EpidemiologyBoston University School of Public Health
  13. 13Boston Health Care for the Homeless Program
  14. 14Department of Health Policy and ManagementHarvard T. H. Chan School of Public HealthBoston, Massachusetts
  15. 15Yale School of Public HealthNew Haven, Connecticut
  16. Correspondence: K. P. Reddy, Medical Practice Evaluation Center, Massachusetts General Hospital, 50 Staniford St, 9th Fl, Boston, MA 02114 (kpreddy@mgh.harvard.edu).

  17. Presented in part: Meetings at Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.

Abstract

Background. In the United States, >40% of people infected with human immunodeficiency virus (HIV) smoke cigarettes.

Methods. We used a computer simulation of HIV disease and treatment to project the life expectancy of HIV-infected persons, based on smoking status. We used age- and sex-specific data on mortality, stratified by smoking status. The ratio of the non-AIDS-related mortality risk for current smokers versus that for never smokers was 2.8, and the ratio for former smokers versus never smokers was 1.0–1.8, depending on cessation age. Projected survival was based on smoking status, sex, and initial age. We also estimated the total potential life-years gained if a proportion of the approximately 248 000 HIV-infected US smokers quit smoking.

Results. Men and women entering HIV care at age 40 years (mean CD4+ T-cell count, 360 cells/μL) who continued to smoke lost 6.7 years and 6.3 years of life expectancy, respectively, compared with never smokers; those who quit smoking upon entering care regained 5.7 years and 4.6 years, respectively. Factors associated with greater benefits from smoking cessation included younger age, higher initial CD4+ T-cell count, and complete adherence to antiretroviral therapy. Smoking cessation by 10%–25% of HIV-infected smokers could save approximately 106 000–265 000 years of life.

Conclusions. HIV-infected US smokers aged 40 years lose >6 years of life expectancy from smoking, possibly outweighing the loss from HIV infection itself. Smoking cessation should become a priority in HIV treatment programs.

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