Lung and Heart Diseases Are Better Predicted by Pack-Years than by Smoking Status or Duration of Smoking Cessation in HIV Patients

• Published in: PloS one Vol. 10; no. 12; p. e0143700
• Main Authors: Guaraldi, Giovanni, Raggi, Paolo, Gomes, André, Zona, Stefano, Marchi, Enrico, Santoro, Antonella, Besutti, Giulia, Scaglioni, Riccardo, Ligabue, Guido, Leipsic, Jonathon, Man, Paul, Sin, Don
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 09-12-2015; Public Library of Science (PLoS)
• Subjects: Abnormalities; Acquired immune deficiency syndrome; AIDS; Airway management; Antiretroviral drugs; Cardiovascular disease; Cardiovascular diseases; Chronic obstructive pulmonary disease; Computed tomography; Coronary artery disease; Coronary vessels; Cross-Sectional Studies; Demographic aspects; Drug addiction; Drug therapy; Emphysema; Female; Health aspects; Health risks; Heart attacks; Heart diseases; Heart Diseases - diagnosis; Heart Diseases - epidemiology; Heart Diseases - etiology; HIV; HIV patients; HIV Seropositivity - complications; HIV Seropositivity - epidemiology; Human immunodeficiency virus; Humans; Infections; Italy - epidemiology; Lung cancer; Lung diseases; Lung Diseases - diagnosis; Lung Diseases - epidemiology; Lung Diseases - etiology; Male; Medical imaging; Metabolism; Middle Aged; Obstructive lung disease; Pathogenesis; Patients; Population; Positron Emission Tomography Computed Tomography; Respiratory tract diseases; Risk Factors; Sexually transmitted diseases; Smoking; Smoking - adverse effects; Smoking Cessation; STD; Thorax; Time Factors; Tomography; Canada
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0143700

The objective of this study was to assess the relationship of pack-years smoking and time since smoking cessation with risk of lung and heart disease.
We investigated the history of lung and heart disease in 903 HIV-infected patients who had undergone thoracic computed tomography (CT) imaging stratified by smoking history. Multimorbidity lung and heart disease (MLHD) was defined as the presence of ≥ 2 clinical or subclinical lung abnormalities and at least one heart abnormality.
Among 903 patients, 23.7% had never smoked, 28.7% were former smokers and 47.6% were current smokers. Spirometry indicated chronic obstructive pulmonary disease in 11.4% of patients and MLHD was present in 53.6%. Age, male sex, greater pack-years smoking history and smoking cessation less than 5 years earlier vs. more than 10 years earlier (OR 2.59, 95% CI 1.27-5.29, p = 0.009) were independently associated with CT detected subclinical lung and heart disease. Pack-years smoking history was more strongly associated with MLHD than smoking status (p<0.001).
MLHD is common even among HIV-infected patients who never smoked and pack- years smoking history is a stronger predictor than current smoking status of MLHD. A detailed pack-years smoking history should be routinely obtained and smoking cessation strategies implemented.