Association of cigarette smoking with HIV prognosis among women in the HAART era: A report from the women's interagency HIV study

Objective. We assessed the association of cigarette smoking with the effectiveness of highly active antiretroviral therapy (HAART) among low-income women. Methods. Data were analyzed from the Women's Interagency HIV Study, a multisite longitudinal study up to 7.9 years for 924 women representing 72% of all women who initiated HAART between July 1, 1995, and September 30, 2003. Results. When Cox's regression was used after control for age, race, hepatitis C infection, illicit drug use, previous antiretroviral therapy, and previous AIDS, smokers on HAART had poorer viral responses (hazard ratio [HR] = 0.79; 95% confidence interval [CI] = 0.67, 0.93) and poorer immunologic response (HR = 0.85; 95% CI = 0.73, 0.99). A greater risk of virologic rebound (HR = 1.39; 95% CI = 1.06, 1.69) and more frequent immunologic failure (HR = 1.52; 95% CI = 1.18, 1.96) were also observed among smokers. There was a higher risk of death (HR = 1.53; 95% CI = 1.08, 2.19) and a higher risk of developing AIDS (HR = 1.36; 95% CI = 1.07, 1.72) but no significant difference between smokers and nonsmokers in the risk of death due to AIDS. Conclusions. Some of the benefits provided by HAART are negated in cigarette smokers.