When Ronni Gutierrez learned she was positive, in 1998, she added a drug for stress reduction: nicotine. “I’ve smoked about a pack a day since,” says Gutierrez, 36, of San Francisco. On highly active antiretroviral therapy (HAART) for five years now, she thought she knew all of smoking’s health risks. Now, a study in the June 2006 issue of the American Journal of Public Health suggests that some women who smoke may be undermining their combo therapy.
Earlier research had determined that smoking damages positive people’s immune systems. After seven years of studying 924 positive women in six U.S. cities, Women’s Interagency HIV Study (WIHS) lead investigator Joseph Feldman, PhD, of SUNY Downstate Medical Center in Brooklyn, says smokers on treatment had higher viral loads and worse immune responses than nonsmokers. “Smokers were 53% more likely to die while on HAART,” Feldman says (though from non-AIDS-related causes).
Smokers were 36% more likely to contract AIDS-related diseases while taking HAART, but researchers found no commonalities among those diseases. “It wasn’t just respiratory problems and cancers like you would expect,” says Monica Gandhi, MD, a study investigator from the University of California at San Francisco.
The worse outcomes can’t be chalked up to poor med adherence: Even smokers who didn’t skip doses were more likely to have low CD4 counts. Researchers say their results could be muddied if the women smoked more when they were already sick, thinking, “I’m ill anyway.”
Says Feldman, “Physicians need to caution women that smoking while on HAART could have serious consequences on treatment and overall longevity.”
Gutierrez defends her habit, calling HIV research confusing. “I never know what to believe,” she says. “I’ve been healthy so far, so I’m not quitting yet.” Even if it does send her CD4 cells up in smoke.