Increased risk of Pneumocystis carinii and community-acquired pneumonia with tobacco use in HIV disease

Maria Jose Miguez-Burbano, David Ashkin, Allan Rodriguez, Robert Duncan, Arthur Pitchenik, Noaris Quintero, Monica Flores, Gail Shor-Posner

Research output: Contribution to journalArticlepeer-review

73 Scopus citations


Objectives: Tobacco smoking-related diseases continue to be of great health concern for the public, in general, and may be particularly deleterious for immunosuppressed HIV-positive individuals, who exhibit widespread tobacco use. Methods: A total of 521 HIV-infected subjects consecutively admitted to Jackson Memorial Hospital between 2001-2002 were enrolled in the study. Research data included a medical history, details of tobacco and illicit drug use and complete computerized hospital information. Blood was drawn to obtain T lymphocyte profiles and viral load levels. Statistical analysis methods included Pearson, Student's t- and Chi-square tests and SAS Proc CATMOD. Results: Tobacco use was prevalent, with 65% of the 521 HIV-positive hospitalized patients being current smokers. Overall, current tobacco users reported smoking an average of 15 ± 13 cigarettes per day for an average of 15 ± 14 years, with 40% smoking more than one pack per day. Pulmonary infections accounted for 49% of the total hospital admissions: 52% bacterial pneumonias, 24% Pneumocystis carinii pneumonia (PCP), 12% non-tuberculous mycobacterial diseases (NTM), 11% tuberculosis and 1% bronchitis. Many of the respiratory patients (46%) had been on highly active antiretroviral therapy (HAART) for over six months and 42% had received PCP and/or NTM prophylaxis. After matching the cases by HAART and CDC stage, the hazardous risk of being hospitalized with a respiratory infection was significantly higher for smokers than non-smokers (95% CI 1.33-2.83; p = 0.003). Respiratory infections were noted in (37%) of the HAART-treated patients, and most (67%) occurred in smokers. CATMOD analyses controlling for HAART, viral load and CD4, indicated that HIV-infected smokers were three times more likely to be hospitalized with PCP and twice as likely to be hospitalized with community-acquired pneumonia than non-smokers, with increased risk related to the number of cigarettes/day in a dose-dependent manner. Conclusions: Tobacco use, which is widespread among HIV-infected subjects, increases the risk of pulmonary diseases, particularly PCP and CAP, two respiratory infections with high prevalence and morbidity risks even in the era of HAART.

Original languageEnglish (US)
Pages (from-to)208-217
Number of pages10
JournalInternational Journal of Infectious Diseases
Issue number4
StatePublished - Jul 2005


  • AIDS
  • HIV
  • PCP
  • Pneumonia
  • T Lymphocytes
  • Tuberculosis

ASJC Scopus subject areas

  • Microbiology (medical)


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