HIV Insight: Lung and Heart Diseases Are Better Predicted by Pack-Years than by Smoking Status or Duration of Smoking Cessation in HIV Patients

BACKGROUND:

The objective of this study was to assess the relationship of pack-years smoking and time since smoking cessation with risk of lung and heart disease.

METHODS:

We investigated the history of lung and heart disease in 903 HIV-infected patients who had undergone thoracic computed tomography (CT) imaging stratified by smoking history. Multimorbidity lung and heart disease (MLHD) was defined as the presence of ≥ 2 clinical or subclinical lung abnormalities and at least one heart abnormality.

RESULTS:

Among 903 patients, 23.7% had never smoked, 28.7% were former smokers and 47.6% were current smokers. Spirometry indicated chronic obstructive pulmonary disease in 11.4% of patients and MLHD was present in 53.6%. Age, male sex, greater pack-years smoking history and smoking cessation less than 5 years earlier vs. more than 10 years earlier (OR 2.59, 95% CI 1.27-5.29, p = 0.009) were independently associated with CT detected subclinical lung and heart disease. Pack-years smoking history was more strongly associated with MLHD than smoking status (p<0.001).

CONCLUSIONS:

MLHD is common even among HIV-infected patients who never smoked and pack- years smoking history is a stronger predictor than current smoking status of MLHD. A detailed pack-years smoking history should be routinely obtained and smoking cessation strategies implemented.

Below: Prevalence of clinical lung diseases by smoking status and pack-years groups. The letters represent each group and when placed on the top of a bar it represents a statistical difference between that bar and the group the letter represent.

Below: Prevalence of subclinical lung conditions by smoking status and pack-years groups. The letters represent each group and when placed on the top of a bar it represents a statistical difference between that bar and the group the letter represent

Below: Prevalence of multimorbidity lung diseases by smoking status and pack-years groups. The letters represent each group and when placed on the top of a bar it represents a statistical difference between that bar and the group the letter represent.