Joseph G. Feldman ^1*, Howard Minkoff ², Michael F. Schneider ³, Stephen J. Gange ³, Mardge Cohen ⁴, D. Heather Watts ⁵, Monica Gandhi ⁶, Robert S. Mocharnuk ⁷, Kathryn Anastos ⁸

¹ SUNY Downstate Medical center
² Maimonides Medical center
³ John Hopkins School Public Health
⁴ Cook County Hospital
⁵ PAMA NICHD
⁶ University of California at San Francisco
⁷ Univ Sothern California,Keck School of Medicine
⁸ Montefiore Medical Center and Lincoln Medical and Mental Heath Center

^* To whom correspondence should be addressed. E-mail: joseph.feldman{at}downstate.edu.

	Abstract

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.

Key Words: HIV/AIDS, Mortality, Tobacco, Women's Health