The effects of smoking on people with HIV

David Rowlands examines why smoking is a particularly serious health threat for people living with HIV and explores a range of interventions and the views of the community based on his latest poll.

Why is smoking more dangerous for people with HIV?

As many as 50-70 per cent of people infected with HIV are smokers. Smoking can interfere with normal lung function in healthy people. In people with HIV, it can make it more difficult to fight off serious infections.

Today, people who have HIV can live just as long as those who don’t, so it’s easy to forget the hazards of the chronic illness. Smoking and related problems can interfere with long-term quality of life and recent studies show that smokers with HIV lose more years of life from smoking than from HIV.

Smoking can also interfere with the processing of medications by the liver. It can also worsen liver problems like hepatitis.

Smoking and side effects

People with HIV who smoke are more likely to suffer complications from HIV medication than those who don’t, often suffering from nausea and vomiting.

Smoking increases the risk of some long-term side effects of HIV disease and treatment. These include osteoporosis (weak bones that can lead to fractures) and osteonecrosis (bone death). HIV treatment slightly increases the risk of heart attack, but smoking is the major controllable risk factor for heart attacks or strokes. Recent studies found that quitting smoking reduced heart attack risk in HIV patients more than other factors such as changes in medications.

Smoking and opportunistic infections

People with HIV who smoke are more likely to develop opportunistic infections related to HIV, including thrush, oral hairy leukoplakia (whitish mouth sores), bacterial pneumonia and pneumocystis pneumonia (PCP). For women, smoking can increase the risk and severity of infection with human papilloma virus (HPV), which increases the risk of cervical disease.

Recently, the bacteria that cause Mycobacterium avium complex (MAC) were linked to smoking. They were found in tobacco, cigarette paper and filters even after they had been burned.

Smoking and risk of death

A recent study found that smoking was linked to a higher rate of death among people with HIV. This was true for current smokers and ex-smokers. The greatest increase in the risk of death was 60 per cent for cardiovascular (heart) disease and some cancers.

Quitting smoking

Quitting is easier said than done, especially since smoking is so entrenched in many niche communities of people with HIV.

Smoking (nicotine) is highly addictive and difficult to stop. There is no one way to give up; some people go ‘cold turkey’ and just stop. Others need some kind of support, ranging from medications that manage the physical symptoms of withdrawal to therapies that deal with the psychological addiction.

Some people alter the routines that encourage them to smoke, get support to reduce outside factors like stress that encourage them to smoke, and participate in motivational groups. Others have success with alternative treatments like acupuncture.


British public health officials have said electronic e-cigarettes should be available on the NHS, despite conflicting evidence over their safety. Britain’s eight million smokers have been urged to start ‘vaping’ after a government-backed report found that the electronic devices are 20 times less harmful than traditional cigarettes.

A new report launched by Public Health England, Kings College London and Queen Mary University of London, found e-cigarettes carry just five per cent of the risk of tobacco and should be widely adopted by smokers.

However several studies have found that the flavours used in e-cigarettes may cause respiratory problems and damage the immune system. E-cigarettes are not completely risk-free but when compared to smoking, evidence shows they carry just a fraction of the harm.

Views of the HIV community

“Smoking is bad for health – so all the normal disclaimers to that apply. In terms of people with HIV, there is an extra risk, but that’s the same with drinking, eating the wrong things etc. My personal view is to assist people to cut down if they wish, or to migrate to e-cigarettes as they contain far fewer chemicals and recent reports suggest that vaping/smoking e-fags are 95 per cent less damaging to health.”

“I smoke but want to give up. I think it’s an individual choice.”

“If HIV and smoking is such a risk why isn’t there more support to quit from the HIV consultants and teams – rather than referring you back to GP/Primary care – they should be providing smoking cessation tools, prescriptions and advice.”

“I quit smoking many years ago, actually when I got diagnosed with HIV. I think smoking with HIV is a very bad idea, but I keep hearing from my peers that smoking helps them cope with stress. I intensely hate now being in places with a lot of smoke.”

“I think smoking is just one of a number of issues that people living with HIV need to address.”

UK smokers urged to sign up to Stoptober

Public Health England is launching the Stoptober campaign to help people stop smoking in October.

To stand an even better chance of quitting, people are encouraged to sign up with their friends, family and colleagues, as evidence reveals that this type of ‘social quitting’ can help dramatically.

Research shows that smokers are two-thirds (67 per cent) more likely to quit when their spouse stops smoking, and a third more likely to quit when a close friend (36 per cent) or someone they work with (34 per cent) stops. The data also shows that individuals are much more likely (61 per cent) to smoke if their partner or a close friend smokes, showing the powerful influence that people’s social networks have on their own smoking behaviour.

By signing up to Stoptober, participants can choose from a range of free support tools, including daily emails and text messages from comedians throughout the 28-day quit attempt, as well as a mobile phone app which includes lots more tips and advice, all of which have shown to increase the chances of staying smoke-free.

Poll data

We asked the HIV community for their views on smoking. There were 89 respondents between 25 August and 24 September 2015, with views collected via online hosting at and social networking sites. Thanks to the members of the community for their input.

The next poll examines patient involvement when collecting data. Click here to take part.

About the author:

David Rowlands is the director of, delivering effective healthcare communications to professionals and patients.

His key objective is to design, develop and deliver community projects to enable people living with, or affected by, HIV and/or HCV to become better engaged with their treatment and care.

Working over a number of media platforms, across the public, private and third sector, he is able to establish a link to these sometimes hard-to-reach communities.

Contact David via Email:,, Twitter @DR_tweetUK

Read more from David Rowlands:

Challenges of ageing for people with HIV