THE ASSOCIATION BETWEEN CIGARETTE-SMOKING AND SELECTED HIV-RELATED MEDICAL CONDITIONS

Objective: To clarify the effect of cigarette smoking on the developme nt of conditions associated with HIV infection. Design: Prospective an d retrospective cohort study, with interview and examination twice a y ear since 1988. Methods: Data on 516 HIV-infected men from cohorts of homosexual and bisexual men in San Francisco, Denver and Chicago, who were repeatedly interviewed and examined between 1988 and 1999, were a nalysed. After excluding men who did not have well-defined dates of se roconversion and those who were classified as ex- or intermittent smok ers, 232 men remained for analysis: 106 were smokers and 126 were non- smokers. Univariate and Kaplan-Meier survival analyses were performed to assess the relationship between cigarette smoking and loss of CD4T-lymphocytes, diagnosis of any AIDS-defining illness, and specific di agnosis of Kaposi's sarcoma, Pneumocystis carinii pneumonia (PCP), ora l candidiasis, hairy leukoplakia, and community-acquired pneumonia. Re sults: By univariate analyses, cigarette smoking was not associated wi th clinical AIDS, loss of CD4+ cells, Kaposi's sarcoma or PCP, but was significantly associated with oral candidiasis [relative risk (RR), 1 .32; 95% confidence interval (CI), 1.02-1.70], hairy leukoplakia (RR, 1.51; 95% CI, 1.15-1.99), and community-acquired pneumonia (RR, 2.62; 95% CI, 1.30-5.27). Dose-response effect was also evident for these th ree conditions (all P < 0.01). Kaplan-Meier survival analysis indicate d no association between cigarette smoking and time of progression to clinical AIDS, Kaposi's sarcoma (KS), or PCP (P = 0.62, 0.54 and 0.11, respectively) but showed that cigarette smokers developed oral candid iasis, hairy leukoplakia, and pneumonia more quickly than non-smokers (P = 0.031, 0.006 and 0.009, respectively). Conclusions: Cigarette smo king was not associated with an increased likelihood or rate of develo ping KS, PCP or AIDS, but was associated with developing community-acq uired pneumonia, oral candidiasis, and hairy leukoplakia in these HIV- infected men.