We all know that smoking is dangerous, and that stopping smoking can improve your health and reduce the risk of smoking-related illnesses whether you’re HIV positive or not. However, smoking can be even more damaging to your health if you have HIV [1].

Smoking has not been shown to make HIV progress any faster than in non-smokers; however, HIV positive smokers are at a higher risk of smoking related illnesses than HIV negative smokers, and smoking has been shown to increase the risk of HIV-related illnesses occurring [2]. 

Compared to HIV negative smokers, HIV positive smokers are at an increased risk of developing illnesses such as:

  • Cardiovascular events such as high blood pressure, heart disease and heart attacks [3]
  • Cerebrovascular events such as strokes [4]
  • Malignancies such as lung cancer, anal cancer, mouth cancer, throat cancer, stomach cancer, head and neck cancer [5]
  • Decreased lung function, chest infections, chronic inflammation of the lungs and airways [6]
  • Emphysema and chronic bronchitis [7]
  • Mouth problems such as gingivitis, periodontitis, thrush and OHL [8]
  • Brain degenerative disorders such as impaired cognitive function and dementia [9]

These illnesses aren’t necessarily more common in HIV positive smokers because of an immune system weakened by HIV. For example, lung cancer is now one of the most common types of non-AIDS defining cancers seen in HIV positive people, and it often occurs in people with high CD4 counts, and therefore with immune systems as strong as you would find in many HIV negative people.

Moreover, illnesses such as lung cancer and emphysema are being diagnosed in HIV positive smokers whilst they are still relatively young – often under the age of 40.

If you have a lower CD4 count and smoke then the risks of you getting an AIDS-defining opportunistic infection are higher, especially those affecting the mouth, lungs and airways. HIV positive smokers with low CD4 counts are therefore at a higher risk of infections such as oral hairy leukoplakia, bacterial pneumonia and thrush. More worryingly, smoking also increases the risk of developing PCP if you have a low CD4 count, and this infection can prove fatal.

You can read more about opportunistic infections in the section on HIV and Your Health.

It’s obvious that you would therefore experience major health benefits from stopping smoking. Some HIV doctors have gone on record as saying that, other than adhering to HIV treatments, stopping smoking is the single most important thing that HIV positive people can do to improve their health and life expectancy. The good news is that with the smoking cessation support and new anti-smoking treatments now available, there’s never been a better time to quit.

Stopping smoking
Read more 

If you want to stop smoking then thinking about the reasons why you don’t want to smoke may give you an incentive. On top of the damage smoking can do to your health, there are financial considerations. A 20-a-day smoker will spend over £2,000 in a year on cigarettes. If you stopped smoking then that £2,000 could buy you a luxury tropical beach holiday every year instead!

If you have decided to stop, then plan ahead so you can prepare yourself. Get rid of ash trays or anything else that reminds you of smoking from your home. If you have difficulty dealing with cravings, remind yourself that cravings will usually pass after five minutes or so. Little tricks like drinking a glass of cold water when you have cravings or distracting yourself by doing something active and keeping busy really can help. Just take it one day at a time and before you know it a month will have passed and you’ll be well on the way to being smoke free.

It may help if you go on a smoking cessation course and use smoking cessation aids such as Nicotine Replacement Therapy (NRT – such as nicotine gum or patches) or one of the drugs Zyban or Champix.

Many local NHS services will offer free generic smoking cessation courses. Speak to your HIV doctor or GP to see what help is available in your area.

Quit is a charity whose aim is to help people to stop smoking. You could call the Quitline on 0800 00 22 00 to talk to a counsellor who will offer confidential help and advice, or visit their website www.quit.org.uk.

You can also find information about how to stop smoking, as well as details of local stop smoking services near where you live on the NHS website www.gosmokefree.co.uk.

Herbal tobacco
Read more 

Some people who experience pain because of their illness, such as men with peripheral neuropathy due to HIV or anti-HIV drugs, use cannabis to help ease the pain. If you do use cannabis and usually smoke it, you’ll need to think about how you’re going to get by without using tobacco. Some people choose to use pipes or even herbal tobacco, whereas others choose to eat the drug instead. Remember though that as well as cannabis being a controlled substance, and as such illegal to supply or possess, continuing to smoke it either through pipes or with herbal tobacco still carries a lot of the health risks that smoking tobacco does. If you choose to eat it, also remember that a small amount goes a long way, and you need much less than if you smoke it. You can read more about cannabis and HIV in the section on Recreational Drugs.

"When I was diagnosed with HIV, I thought, like many recently diagnosed men, 'that's it, I'm dying young so I may as well live fast'. I saw no need to change any of my many bad habits, I reckoned AIDS was going to get me before cancer did. Four years and lots of encouraging treatment news later it was time to re-evaluate. I was approaching 35, a scary age for many gay men, and had been nursing my 20 a day habit (40 on party nights) for fully half my lifetime. I'd tried to ignore all of the health warnings about HIV positive smokers being more susceptible to cancer and other respiratory illnesses but I was old enough and ugly enough now to take the truth. I had to say to myself, 'what about my life to date makes me think that I'm not going to get cancer?' It also had become clear to me that cigarettes didn't actually calm my nerves, just that their absence stressed me out. If I could just get over that withdrawal I should feel less stressed generally. I'd tried to stop before and failed, so this time I joined a group. I can't say that everything about the Stop Smoking Course appealed to me, however it did mean that by the time I got to the quit date I'd invested so much effort already that I was determined not to fail again. I used nicotine patches for about two and a half months, which helped me not to think about how much I missed my little tubes of delight. After that time I was so over the whole fag thing I was amazed to think I'd wasted all that time and all of that money smoking. The money in your pocket at the beginning of the day is often still there at the end of the day, and suddenly you find you can afford exotic holidays and nice meals out (my habit had been costing me about £2000 per year) and the whole concept of smoking seems rather silly to me now. Also I'm back to thinking that I may live long enough to retire now, so I'll probably be needing that extra cash." (Mark, 37).