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This Article Figures Only Full Text Full Text (PDF) All Versions of this Article: AJPH.2005.062745v1 96/6/1060    most recent Submit a response Purchase Article View Shopping Cart Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Similar articles in this journal Similar articles in ISI Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via ISI Web of Science (10) Citing Articles via Google Scholar Google Scholar Articles by Feldman, J. G. Articles by Anastos, K. Search for Related Content PubMed PubMed Citation Articles by Feldman, J. G. Articles by Anastos, K. Related Collections HIV/AIDS Mortality Other Tobacco Women's Health

Joseph G. Feldman, DrPH, Howard Minkoff, MD, Michael F. Schneider, MS, Stephen J. Gange, PhD, Mardge Cohen, MD, D. Heather Watts, MD, Monica Gandhi, MD, Robert S. Mocharnuk, MD and Kathryn Anastos, MD

Joseph G. Feldman is with the Department of Preventive Medicine and Community Health, SUNY Health Sciences Center at Brooklyn, New York, NY. Howard Minkoff is with the Department of Obstetrics and Gynecology, Maimonides Medical Center and SUNY Health Sciences Center at Brooklyn. Michael F. Schneider and Stephen J. Gange are with the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md. Mardge Cohen is with Cook County Hospital, Chicago, Ill. D. Heather Watts is with Pediatric, Adolescent and Maternal AIDS, National Institute of Child Health and Human Development, Bethesda, Md. Monica Gandhi is with the Department of Medicine, University of California, San Francisco, Calif. Robert S. Mocharnuk is with the University of Southern California, Keck School of Medicine, Los Angeles. Kathryn Anastos is with the departments of Medicine and Epidemiology and Population Health, Montefiore Medical Center, Bronx, NY.

Correspondence: Requests for reprints should be sent to Joseph G. Feldman, Box 43 SUNY Downstate Medical Center, 450 Clarkson Ave, Brooklyn, NY 11203 (e-mail: joseph.feldman{at}downstate.edu).

Objective. We assessed the association of cigarette smoking with the effectiveness of highly active antiretroviral therapy (HAART) among low-income women.

Methods. Data were analyzed from the Women’s Interagency HIV Study, a multisite longitudinal study up to 7.9 years for 924 women representing 72% of all women who initiated HAART between July 1, 1995, and September 30, 2003.

Results. When Cox’s regression was used after control for age, race, hepatitis C infection, illicit drug use, previous antiretroviral therapy, and previous AIDS, smokers on HAART had poorer viral responses (hazard ratio [HR]=0.79; 95% confidence interval [CI]=0.67, 0.93) and poorer immunologic response (HR=0.85; 95% CI=0.73, 0.99). A greater risk of virologic rebound (HR=1.39; 95% CI=1.06, 1.69) and more frequent immunologic failure (HR=1.52; 95% CI=1.18, 1.96) were also observed among smokers. There was a higher risk of death (HR=1.53; 95% CI=1.08, 2.19) and a higher risk of developing AIDS (HR=1.36; 95% CI=1.07, 1.72) but no significant difference between smokers and nonsmokers in the risk of death due to AIDS.

Conclusions. Some of the benefits provided by HAART are negated in cigarette smokers.

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