Smoking and Disease Progression


Smoking and Disease Progression

Being Alive Newsletter, Being Alive/Los Angeles - May 1993
Garance Franke-Ruta

Because of smoking's general effects on the immune system and the body, some researchers have hypothesized that smoking in early HIV disease may increase the risk of progression to AIDS by activating T4 cells, thus facilitating HIV replication. A study from the Food and Drug Administration (FDA) provides preliminary evidence that, at least in the test tube, constituents of cigarette smoke induce HIV production in chronically infected cells.

A British group of researchers retrospectively reviewed the smoking status of people with AIDS in a lung study they were conducting. They saw a more rapid progression to AIDS and a higher risk of developing Pneumocystis carinii pneumonia (PCP) in those who were smokers than in nonsmokers (a group that included former smokers). Further analysis showed no difference between smokers and nonsmokers in progression to non-PCP AIDS. The authors recommend that, in addition to T4 count, the effects of smoking on lung function be taken into account when prescribing PCP prophylaxis, since smokers' decreased lung function seems to place them at a higher risk of developing PCP than their nonsmoking counterparts.

Other studies have found little or no effect of smoking on disease progression. A study of Haitian men and women found that smoking status was not associated with changes in T4 cell percentages or beta-2-microglobulin (a measure of immune system activation).

A long-term follow-up study of 202 gay men found that T4 counts and serum beta-2-microglobulin levels were elevated in smokers compared to nonsmokers following seroconversion. However, this difference in immune parameters disappeared after two years and had no impact on clinical outcomes such as AIDS or the development of PCP. Another study of 249 men in Canada with HIV found no association between smoking and the development of AIDS.

A long-term study of HIV-infected and uninfected men found that, across the board, smokers had higher T4 counts; however, this difference was less marked for those who were HIV-infected. The authors also found that of those participants who seroconverted, smokers' T4 counts fell faster than nonsmokers' counts.
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