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HIV Probably Won't Kill You, but Smoking Will

HIV-positive people smoke at more than twice the rate of the general population. Doctors say smoking now presents a greater risk to them than HIV itself.
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Compared to the general population, an abnormally high rate of Americans living with HIV are smokers: By one 2009 study’s count, 50 to 70 percent of HIV-positive people smoke; another from 2016 estimated it’s at least more than 40 percent. “That’s more than double the rate of smoking in the general population,” said Krishna P. Reddy, a Boston-based doctor and researcher specializing in HIV comorbidities.


Today, medical breakthroughs mean HIV-positive people can have near-normal life expectancy rates—but not if you smoke. Dr. Reddy was the lead researcher on a study published this November in JAMA Internal Medicine, examining lung cancer mortality rates for smokers living with HIV. His results were shocking: HIV-positive smokers are six to 13 times more likely to die from lung cancer than from traditional AIDS-related causes.

I have HIV, and every time I visit my doctor for a routine checkup, he says the same thing: “HIV isn't going to kill you, but smoking will." And it’s true: No matter how diligently HIV patients adhere to their drug regimen, if they smoke, they can't claim to be taking care of themselves. “For those on HIV medicines, smoking is a much bigger threat to health than HIV itself,” said Reddy, who emphasized that lung cancer, rather than complications due to the virus, is now one of the leading causes of death for people with HIV.

According to the JAMA study, HIV-positive men and women who smoked daily faced high lung cancer mortality rates—23 percent for men and 20.9 percent for women. But if they quit smoking, those risks decreased dramatically—dropping to 6.1 percent and 5.2 percent. That means quitting smoking now could potentially add years, if not decades, to your lifespan.

"This is a great reminder of the effectiveness of current HIV treatments to prevent disease progression,” said Richard Wolitski, director of the Office for HIV/AIDS at the Department of Health and Human Services. “For the first half of the epidemic, it was a harsh reality that we did not see the effects of smoking on people living with HIV, because they became sick and died so quickly of AIDS." People living with HIV today can live longer lives, Wolitski admits, “but smoking is a significant and critical threat to the health of those individuals, even those who take HIV medications every day as prescribed. If we want to save the lives of people with HIV, we also have to tackle smoking and other health threats.”


Meet the blogger chronicling his life with HIV:

After smoking for a decade, roughly three months ago I decided to quit. Warning signs of smoking’s health effects began manifesting as alarming cramps near my heart or a racing heartbeat, and they were happening with increasing frequency. As I set my mind on quitting for good, I felt the onset of depression settle in. Not being able to smoke cigarettes during work breaks and in social settings felt quite literally depressing, but it didn’t last long. Obviously you don’t actually need cigarettes to cope with stress or to socialize, despite the glut of added stress that people living with HIV go through.

After the first two predictably rough days of quitting, I started to forget how badly I thought that I needed cigarettes. Cravings that once happened every four hours began to happen every four days. That said, the sheer force of nicotine addiction shouldn’t be underestimated—quitting is incredibly hard. But it’s something I’m committed to. Despite a brief post-quitting weight gain and various adjustments I’ve had to make in my lifestyle, overall, quitting has been highly worth it.

By the time I was past the first week, I was rarely thinking about a cigarette. And knowing how much money I’m saving, the health benefits I’m accruing, and the length I’m adding to my lifespan helps keep me motivated. The sweet feeling of accomplishment I’ve seen just from staying smoke-free the past three months has made me feel like I can conquer any hurdle. There's no need to feel ashamed or guilty about smoking—just quit and do it for yourself. Your lifespan depends on it.

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