Tobacco smoking, smoking cessation and life expectancy among people with HIV on antiretroviral therapy in South Africa: a simulation modelling study

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dc.date.accessioned 2024-11-21T08:04:02Z
dc.date.available 2024-11-21T08:04:02Z
dc.date.issued 2024-10-21 en
dc.identifier.uri http://hdl.handle.net/20.500.11910/23562
dc.description.abstract As access to effective antiretroviral therapy (ART) has improved globally, tobacco‐related illnesses, including cardiovascular disease, cancer and chronic respiratory conditions, account for a growing proportion of deaths among people with HIV (PWH). We estimated the impact of tobacco smoking and smoking cessation on life expectancy among PWH in South Africa. In a microsimulation model, we simulated 18 cohorts of PWH with virologic suppression, each homogenous by sex, initial age (35y/45y/55y) and smoking status (current/former/never). Input parameters were from data sources published between 2008 and 2022. We used South African data to estimate age-stratified mortality hazard ratios: 1.2−2.3 (females)/1.1−1.9 (males) for people with current versus never smoking status; and 1.0−1.3 (females)/1.0−1.5 (males) for people with former versus never smoking status, depending on age at cessation. We assumed smoking status remains unchanged during the simulation; people who formerly smoked quit at model start. Simulated PWH face a monthly probability of disengagement from care and virologic non-suppression. In sensitivity analysis, we varied smoking-associated and HIV-associated mortality risks. Additionally, we estimated the total life-years gained if a proportion of all virologically suppressed PWH stopped smoking.Forty-five-year-old females/males with HIV with virologic suppression who smoke lose 5.3/3.7 life-years compared to PWH who never smoke. Smoking cessation at age 45y adds 3.4/2.4 life-years. Simulated PWH who continue smoking lose more life-years from smoking than from HIV (females, 5.3 vs. 3.0 life-years; males, 3.7 vs. 2.6 life-years). The impact of smoking and smoking cessation increase as smoking-associated mortality risks increase and HIV-associated mortality risks, including disengagement from care, decrease. Model results are most sensitive to the smoking-associated mortality hazard ratio; varying this parameter results in 1.0−5.1 life-years gained from cessation at age 45y. If 10−25% of virologically suppressed PWH aged 30−59y in South Africa stopped smoking now, 190,000−460,000 life-years would be gained. Among virologically suppressed PWH in South Africa, tobacco smoking decreases life expectancy more than HIV. Integrating tobacco cessation interventions into HIV care, as endorsed by the World Health Organization, could substantially improve life expectancy. en
dc.format.medium Print en
dc.subject ANTIRETROVIRAL THERAPY (ART) en
dc.subject TOBACCO CESSATION en
dc.subject HIV/AIDS en
dc.subject LUNG DISEASES en
dc.subject SMOKING en
dc.subject LIFE EXPECTANCY en
dc.title Tobacco smoking, smoking cessation and life expectancy among people with HIV on antiretroviral therapy in South Africa: a simulation modelling study en
dc.type Journal Article en
dc.description.version Y en
dc.ProjectNumber PVAQAA en
dc.Volume 27(6) en
dc.BudgetYear 2024/25 en
dc.ResearchGroup Public Health, Societies and Belonging en
dc.SourceTitle Journal of the International AIDS Society en
dc.ArchiveNumber 9814642 en
dc.PageNumber Online en
dc.outputnumber 15299 en
dc.bibliographictitle Thielking, A.M., Fitzmaurice , K.P., Sewpaul, R., Chrysanthopoulou , S.A., Dike, L., Levy, D.E., Rigotti , N.A., Siedner , M.J., Wood , R., Paltiel , D., Freedberg , K.A., Hyle, E.P. & Reddy, K. (2024) Tobacco smoking, smoking cessation and life expectancy among people with HIV on antiretroviral therapy in South Africa: a simulation modelling study. Journal of the International AIDS Society. 27(6):Online. http://hdl.handle.net/20.500.11910/23562 en
dc.publicationyear 2024 en
dc.contributor.author1 Thielking, A.M. en
dc.contributor.author2 Fitzmaurice , K.P. en
dc.contributor.author3 Sewpaul, R. en
dc.contributor.author4 Chrysanthopoulou , S.A. en
dc.contributor.author5 Dike, L. en
dc.contributor.author6 Levy, D.E. en
dc.contributor.author7 Rigotti , N.A. en
dc.contributor.author8 Siedner , M.J. en
dc.contributor.author9 Wood , R. en
dc.contributor.author10 Paltiel , D. en
dc.contributor.author11 Freedberg , K.A. en
dc.contributor.author12 Hyle, E.P. en
dc.contributor.author13 Reddy, K. en


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