Inflammation in Relation to Intensity and Duration of Cigarette Smoking Among People Living with HIV


Both inflammation and smoking are independent predictors of morbidity and mortality among people living with HIV (PLHIV). As smoking burden is likely to exacerbate inflammation, we tested the hypothesis that higher intensity and longer duration of smoking are positively associated with C-reactive protein (CRP, an inflammatory marker) among 284 PLHIV in Kathmandu, Nepal. We measured smoking status, intensity of smoking, smoking duration, and CRP concentrations. In total, 22.9% of never smokers, 24.3% former smokers, and 34.1% current smokers had high CRP (> 3 mg/l). The median intensity and duration of smoking were 12 (cigarettes/day) and 19 years, respectively. Intensity of smoking (beta for increase in number of cigarettes/day: β = 0.245; p = 0.017), smoking duration (beta for 1-year increase in smoking: β = 0.341; p = 0.013), and pack-years of smoking (beta for 1-pack-years of smoking increase: β = 0.351; p = 0.002) were each positively associated with CRP concentrations. While quitting is important, reducing the intensity and duration of smoking until quitting might be helpful in reducing the levels of inflammation, thereby in mitigating HIV-related harms.

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We acknowledge all the study participants of this study for their time, information, and participation. We also thank interviewers and laboratory technicians for their hard work in collecting the data, separating serum, and processing samples. We sincerely acknowledge five non-governmental organizations (Shakti Milan Samuha, SPARSHA Nepal, Sneha Samuha, Srijansil Mahila Samaj, and Youth Vision) for their support in recruiting study participants and providing venues for collecting data.


The fieldwork of this study was partially supported by a Grant for Research on Global Health and Medicine (Grant No. 21A-2) from the National Center for Global Health and Medicine, Japan and by a Grant-in-Aid for Young Scientists (Grant No. B22790581), Japan Society for the Promotion of Science, Ministry of Education, Culture, Sports, Science and Technology, Japan. This study was also supported by a grant from the University of Massachusetts Amherst, MA, USA. Funding agencies did not have any role in the study design; the collection, analysis, and interpretation of data; writing the manuscript; or the decision to submit the article for publication.

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Correspondence to Krishna C. Poudel.

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Poudel, K.C., Poudel-Tandukar, K., Bertone-Johnson, E.R. et al. Inflammation in Relation to Intensity and Duration of Cigarette Smoking Among People Living with HIV. AIDS Behav 25, 856–865 (2021).

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  • Smoking
  • HIV
  • Inflammation
  • C-reactive protein