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A Closer Look: Q&A with Marie Helleberg

marie_hellebergMarie Helleberg is a doctor and researcher at the University Hospital of Copenhagen, Rigshospitalet, Denmark. She recently completed a study on the effects of smoking on mortality for those living with HIV.

What led you to design a study to evaluate the effect of smoking on mortality among people with HIV?

With access to specialized care and highly active antiretroviral therapy free of charge, the HIV-related mortality rate has decreased tremendously, though it is still higher than the rest of the population. We thought that this increased mortality might be caused by lifestyle-related factors rather than by the HIV infection itself. Smoking claims many lives and is more prevalent among HIV-infected individuals. We therefore aimed to assess how many years of life are lost due to smoking for those with HIV compared with people of the same age and gender who are HIV-negative.

Can you briefly describe your findings and what you calculate the life expectancy to be for people with HIV who are smokers or nonsmokers?

We found that HIV-infected individuals engaged in care lose more years of life to smoking than to the HIV infection. We estimated that a 35-year-old HIV-infected individual, who smokes, loses 13 years of life due to smoking, but only 5 years due to HIV. The loss of years due to smoking was much higher among HIV-positive individuals than HIV-negative individuals.  We concluded that more than 60% of deaths among HIV-positive folks were associated with smoking.  We calculated that the median life expectancy was 62.6 years for 35-year-old HIV-positive individuals who smoke, and 78.4 years for nonsmoking HIV-positive individuals.

What else would you like to research regarding smoking and mortality among people who are HIV-positive?

The very high mortality rate among people living with HIV who smoke may not only be caused by the biological toxic effects of cigarettes. Socio-economic factors may also impact mortality. We aim to investigate how education, occupation and income affect smoking behavior and mortality.

What are the implications of your study for HIV care?

The study underlines the importance of prioritizing programs for smoking cessation. It illustrates that counseling on smoking cessation should be part of the routine care of HIV patients.

How were you able to conduct this research?

In Denmark, opportunities to study morbidity and mortality among people living with HIV are unique, as all individuals have been followed prospectively since 1995. The civil registration system allows linkage to nationwide registries providing data on hospital contacts, psychiatric and non-psychiatric diagnoses, pathological investigations, socio-economic status etc. Further, we can extract similar data on matched control groups from the background population.

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