Mortality Attributable to Smoking Among HIV-1-Infected Individuals: A Nationwide, Population-Based Cohort Study
Mortality Attributable to Smoking Among HIV-1-Infected Individuals: A Nationwide, Population-Based Cohort Study
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DOI：
10.1093/cid/cis933
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发表时间：
2013-03-01
影响因子：
11.8
通讯作者：
Obel, Niels
中科院分区：
文献类型：
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作者：
Helleberg, Marie;Afzal, Shoaib;Obel, Niels
背景。我们评估了人类免疫缺陷病毒 (HIV) 患者因吸烟导致的死亡率。方法。我们评估了基于人群的全国性 HIV 队列和匹配的 HIV 阴性个体队列中当前和不吸烟个体中与吸烟和 HIV 相关的死亡率 (MR)、死亡率比 (MRR)、预期寿命、损失生命年以及人群归因的死亡风险。结果。总共对 2921 名 HIV 患者和 10 642 名对照者进行了随访，随访时间分别为 14 281 人和 45 122 人年。与不吸烟的 HIV 患者相比，吸烟的全因死亡率和非艾滋病相关死亡率显着增加（MRR 分别为 4.4 [95% 置信区间 {CI}，3.0-6.7] 和 5.3 [95% CI，3.2-8.8]）。 HIV 患者与非吸烟者相比，每 1000 人年的超额 MR 为 17.6（95% CI，13.3-21.9），对照组为 4.8（95% CI，3.2-6.4）。一名 35 岁的 HIV 患者吸烟者的中位预期寿命为 62.6 岁（95% CI，59.9-64.6），非吸烟者的中位预期寿命为 78.4 岁（95% CI，70.8-84.0）；与吸烟和艾滋病毒相关的生命年损失数量分别为 12.3 (95% CI, 8.1-16.4) 和 5.1 (95% CI, 1.6-8.5)。 HIV 患者中与吸烟相关的人口归因死亡风险为 61.5%，对照组为 34.2%。结论。在艾滋病毒护理组织良好且免费抗逆转录病毒治疗的环境中，感染艾滋病毒的吸烟者因吸烟而损失的生命年比因艾滋病毒而损失的寿命更长。与背景人群相比，艾滋病毒患者中吸烟者的超额死亡率增加了两倍，与吸烟相关的人群归因的死亡风险增加了一倍。
Background. We assessed mortality attributable to smoking among patients with human immunodeficiency virus (HIV).Methods. We estimated mortality rates (MRs), mortality rate ratios (MRRs), life expectancies, life-years lost, and population-attributable risk of death associated with smoking and with HIV among current and nonsmoking individuals from a population-based, nationwide HIV cohort and a cohort of matched HIV-negative individuals.Results. A total of 2921 HIV patients and 10 642 controls were followed for 14 281 and 45 122 person-years, respectively. All-cause and non-AIDS-related mortality was substantially increased among smoking compared to nonsmoking HIV patients (MRR, 4.4 [95% confidence interval {CI}, 3.0-6.7] and 5.3 [95% CI, 3.2-8.8], respectively). Excess MR per 1000 person-years among current vs nonsmokers was 17.6 (95% CI, 13.3-21.9) for HIV patients and 4.8 (95% CI, 3.2-6.4) for controls. A 35-year-old HIV patient had a median life expectancy of 62.6 years (95% CI, 59.9-64.6) for smokers and 78.4 years (95% CI, 70.8-84.0) for nonsmokers; the numbers of life-years lost in association with smoking and HIV were 12.3 (95% CI, 8.1-16.4) and 5.1 (95% CI, 1.6-8.5). The population-attributable risk of death associated with smoking was 61.5% among HIV patients and 34.2% among controls.Conclusions. In a setting where HIV care is well organized and antiretroviral therapy is free of charge, HIV-infected smokers lose more life-years to smoking than to HIV. The excess mortality of smokers is tripled and the population-attributable risk of death associated with smoking is doubled among HIV patients compared to the background population.