Reddy KP, et al. - An illustration was entailed in this research of the cumulative lung cancer mortality by smoking exposure among people living with human immunodeficiency virus (HIV) (PLWH) in care. A greater tendency prevailed of death from lung cancer among those PLWH who adhered to antiretroviral therapy (ART) but continued smoking than from AIDS-related causes.

Methods

• Standard demographic data and recent HIV/AIDS epidemiology statistics were applied herein, with specific details on smoking exposure, combining smoking status (current, former, or never) and intensity (heavy, moderate, or light) via 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 and accounted for an HIV-conferred independent risk of lung cancer.
• It was determined that the lung cancer mortality risk ratios (vs never smokers) for male and female current moderate smokers were 23.6 and 24.2, respectively, and for those who quit smoking at age 40 years were 4.3 and 4.5.
• The sensitivity analyses accounted for 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).
• 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 were included as the main outcome measure.

Results

• 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%, for 40-year-old men with HIV.
• Among women, 27.8%, 20.9%, and 16.6% were the corresponding mortality for current smokers; for former smokers, it was 7.5%, 5.2%, and 3.7%; and for never smokers, it was 1.2%.
• ART-adherent individuals who continued to smoke displayed 6 to 13 times greater tendency of dying from lung cancer than from traditional AIDS-related causes, based on sex and smoking intensity.
• Those with incomplete ART adherence illustrated higher overall mortality but lower lung cancer mortality, owing to the increased AIDS-related mortality risks.
• It was unveiled that 59900 (9.3%) were expected to die from lung cancer if smoking habits did not alter, applying model projections to the approximately 644200 PLWH aged 20 to 64 in care in the United States.