Special Coverage of 43rd IDSA Meeting
Study finds negative impact of smoking on HIV infection and immune activation
Research dating from the late 1990s has found that abnormal immune activation can lead to lipodystrophy syndrome, which now is broken down to lipoatrophy and lipohypertrophy, an investigator says.
"There were studies in the late 1990s and early 2000 about the effects of smoking on the immune system, and a lot of these articles were done from cardiovascular studies," says Richard A. Go, MD, a second-year fellow at Stony Brook University Hospital at State University of New York in Stony Brook, NY.
The research found that an increase in smoking was associated with a lack of sustained viral suppression.1
Investigators found an inverse relationship between the amount of packs of cigarettes smoked per day and the number of months of continuous viral suppression.1
"Our original thoughts were if you had an HIV patient who was smoking, they would do worse in their clinical course," Go says.
After reviewing data of 340 patients and looking at smoking history, course of HIV, how well the virus is suppressed, and how well the patients have done, it appears that investigators are finding trends that smoking is associated with lipodystrophy, Go explains.
"The statistical analysis is showing a trend toward that, but we still need more data," Go says. "We need to increase the number of patients we have in the study."
The study will continue to enroll patients through the end of 2005. So far, 58% of those enrolled are smokers, Go says.
"The database went so far as to look at the medications the patient was taking and how well controlled they were on the medication, including whether the viral load was suppressed," Go says. "The data looked at whether they were smokers, male/female ratio and whether that had an effect, age, numbers of other disease states, and whether they’re also diabetic, have hypertension, or on any medication that may affect the immune system."
About 40% of the 340 patients enrolled through the early fall had lipodystrophy, Go adds.
This research joins others that are attempting to find the causes of lipodystrophy, he adds.
In the late 1990s, researchers noticed that patients on certain protease inhibitors (PIs) seemed to have more severe forms of lipodystrophy, which led people to believe the PIs were responsible, Go says.
"Now people are noticing that it may not be the PI itself, but it may be part of the HIV disease," Go says. "Now doctors are looking for lipodystrophy symptoms, and are finding them in more patients."
One possibility could be the PIs had somehow agitated immune systems to lead to a more exaggerated course of lipodystrophy, so that it was noticed in patients earlier, Go adds.
"We’re not sure what is causing lipodystrophy itself, but there are a number of factors to consider when someone may develop lipodystrophy, and these are medications, viral control, immune activation from smoking, and other disease states," Go says.
Studies have shown that patients with prior or current smoking history have abnormal markers of immune activation, especially in cardiovascular studies, Go says.
"What they haven’t been able to determine is whether it’s a direct cause or whether smoking led to it or something else," Go explains. "No one has pinned it down exactly and, at this point, as everyone is getting more data, maybe we’ll get closer to the causes or potential causes of the problems."
In the meantime, the take-home message of the smoking and HIV research is that smoking can do more damage than what already is known to people infected with HIV, Go says.
"Clinicians should try to explain to their patients that their lifestyle changes can affect the disease," Go says. "Hopefully they can warn patients to quit smoking."
Reference:
- Go RA, Chirch LM, Steigbigel RT. Effect of smoking on course of HIV infection and immune activation. Presented at the 43rd Annual Meeting of the Infectious Diseases Society of America, Oct. 6-9, 2005, in San Francisco, CA. Abstract: 765.
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