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.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Tax calculation will be finalised during checkout.
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
Tax calculation will be finalised during checkout.
Mdodo R, Frazier EL, Dube SR, et al. Cigarette smoking prevalence among adults with HIV compared with the general adult population in the United States: cross-sectional surveys. Ann Intern Med. 2015;162(5):335–44.
Helleberg M, May MT, Ingle SM, et al. Smoking and life expectancy among HIV-infected individuals on antiretroviral therapy in Europe and North America. AIDS. 2015;29(2):221–9.
Clifford GM, Polesel J, Rickenbach M, et al. Cancer risk in the Swiss HIV Cohort Study: associations with immunodeficiency, smoking, and highly active antiretroviral therapy. J Natl Cancer Inst. 2005;97(6):425–32.
Helleberg M, Afzal S, Kronborg G, et al. Mortality attributable to smoking among HIV-1-infected individuals: a nationwide, population-based cohort study. Clin Infect Dis. 2013;56(5):727–34.
Shiboski CH, Neuhaus JM, Greenspan D, Greenspan JS. Effect of receptive oral sex and smoking on the incidence of hairy leukoplakia in HIV-positive gay men. J Acquir Immune Defic Syndr. 1999;21(3):236–42.
Slavinsky J 3rd, Myers T, Swoboda RK, Leigh JE, Hager S, Fidel PL Jr. Th1/Th2 cytokine profiles in saliva of HIV-positive smokers with oropharyngeal candidiasis. Oral Microbiol Immunol. 2002;17(1):38–433.
Metersky ML, Colt HG, Olson LK, Shanks TG. AIDS-related spontaneous pneumothorax Risk factors and treatment. Chest. 1995;108(4):946–51.
Winstone TA, Man SFP, Hull M, Montaner JS, Sin DD. Epidemic of lung cancer in patients with HIV infection. Chest. 2013;143(2):305–14.
Reddy KP, Kong CY, Hyle EP, et al. Lung cancer mortality associated with smoking and smoking cessation among people living with HIV in the United States. JAMA Intern Med. 2017;177:1613–21.
Lifson AR, Neuhaus J, Arribas JR, van den Berg-Wolf M, Labriola AM, Read TR. Smoking-related health risks among persons with HIV in the Strategies for Management of Antiretroviral Therapy clinical trial. Am J Public Health. 2010;100(10):1896–903.
Abbud RA, Finegan CK, Guay LA, Rich EA. Enhanced production of human immunodeficiency virus type 1 by in vitro-infected alveolar macrophages from otherwise healthy cigarette smokers. J Infect Dis. 1995;172(3):859–63.
Valiathan R, Miguez MJ, Patel B, Arheart KL, Asthana D. Tobacco smoking increases immune activation and impairs T-cell function in HIV infected patients on antiretrovirals: a cross-sectional pilot study. PLoS ONE. 2014;9(5):e97698.
Feldman JG, Minkoff H, Schneider MF, et al. Association of cigarette smoking with HIV prognosis among women in the HAART era: a report from the women's interagency HIV study. Am J Public Health. 2006;96(6):1060–5.
Ehren K, Hertenstein C, Kummerle T, et al. Causes of death in HIV-infected patients from the Cologne-Bonn cohort. Infection. 2014;42(1):135–40.
May MT, Ingle SM, Costagliola D, et al. Cohort profile: Antiretroviral Therapy Cohort Collaboration (ART-CC). Int J Epidemiol. 2014;43(3):691–702.
Weber R, Ruppik M, Rickenbach M, et al. Decreasing mortality and changing patterns of causes of death in the Swiss HIV Cohort Study. HIV Med. 2013;14(4):195–207.
Crothers K, Griffith TA, McGinnis KA, et al. The impact of cigarette smoking on mortality, quality of life, and comorbid illness among HIV-positive veterans. J Gen Intern Med. 2005;20(12):1142–5.
Turner J, Page-Shafer K, Chin DP, et al. Adverse impact of cigarette smoking on dimensions of health-related quality of life in persons with HIV infection. AIDS Pat Care STDS. 2001;15(12):615–24.
Deeks SG, Tracy R, Douek DC. Systemic effects of inflammation on health during chronic HIV infection. Immunity. 2013;39(4):633–45.
Feldman JG, Goldwasser P, Holman S, DeHovitz J, Minkoff H. C-reactive protein is an independent predictor of mortality in women with HIV-1 infection. J Acquir Immune Defic Syndr. 2003;32(2):210–4.
Lau B, Sharrett AR, Kingsley LA, et al. C-reactive protein is a marker for human immunodeficiency virus disease progression. Arch Intern Med. 2006;166(1):64–70.
Stampfli MR, Anderson GP. How cigarette smoke skews immune responses to promote infection, lung disease and cancer. Nat Rev Immunol. 2009;9(5):377–84.
Yanbaeva DG, Dentener MA, Creutzberg EC, Wesseling G, Wouters EF. Systemic effects of smoking. Chest. 2007;131(5):1557–666.
Hosseinzadeh A, Thompson PR, Segal BH, Urban CF. Nicotine induces neutrophil extracellular traps. J Leukoc Biol. 2016;100(5):1105–12.
Cioe PA, Baker J, Kojic EM, et al. Elevated soluble CD14 and lower D-dimer are associated with cigarette smoking and heavy episodic alcohol use in persons living with HIV. J Acquir Immune Defic Syndr. 2015;70(4):400–5.
Kooij KW, Wit FW, Booiman T, et al. Cigarette smoking and inflammation, monocyte activation, and coagulation in HIV-infected individuals receiving antiretroviral therapy, compared with uninfected individuals. J Infect Dis. 2016;214(12):1817–21.
Armah KA, McGinnis K, Baker J, et al. HIV status, burden of comorbid disease, and biomarkers of inflammation, altered coagulation, and monocyte activation. Clin Infect Dis. 2012;55(1):126–36.
WHO. Tobacco, WHO Fact sheet N 339. Geneva: World Health Organization; 2015.
UNAIDS. UNAIDS data 2017. Geneva: Joint United Nations Programme on HIV/AIDS; 2017.
Poudel KC, Bertone-Johnson ER, Poudel-Tandukar K. Serum zinc concentration and C-reactive protein in individuals with human immunodeficiency virus infection: the positive living with HIV (POLH) study. Biol Trace Elem Res. 2016;171(1):63–70.
Poudel-Tandukar K, Jacelon CS, Bertone-Johnson ER, Palmer PH, Poudel KC. Serum albumin levels and depression in people living with Human Immunodeficiency Virus infection: a cross-sectional study. J Psychosom Res. 2017;101:38–433.
Poudel KC, Buchanan DR, Poudel-Tandukar K. Delays in antiretroviral therapy initiation among HIV-positive individuals: results of the positive living with HIV study. Glob Health Action. 2016;9:31550.
Ministry of Health, Nepal; New ERA; and ICF. Nepal Demographic and Health Survey 2016. Kathmandu: Ministry of Health, Nepal; 2017.
Amiya RM, Poudel KC, Poudel-Tandukar K, Kobayashi J, Pandey BD, Jimba M. Physicians are a key to encouraging cessation of smoking among people living with HIV/AIDS: a cross-sectional study in the Kathmandu Valley, Nepal. BMC Public Health. 2011;11:677.
Bhatta DN, Subedi A, Sharma N. Tobacco smoking and alcohol drinking among HIV infected people using antiretroviral therapy. Tob Induc Dis. 2018;16:16.
NCASC. Fact sheets: HIV Epidemic Update of Nepal, Nepal, 2018. Kathmandu: National Centre for AIDS and STD Control; 2018. Access February 4, 2020; https://www.ncasc.gov.np/WAD2018/FACTSHEET-2018-FINAL/Factsheet-2018-final.pdf.
Poudel KC, Nakahara S, Poudel-Tandukar K, Yasuoka J, Jimba M. Unsafe sexual behaviors among HIV-positive men in Kathmandu Valley, Nepal. AIDS Behav. 2009;13(6):1143–50.
Poudel KC, Poudel-Tandukar K, Nakahara S, Yasuoka J, Jimba M. Knowing the consequences of unprotected sex with seroconcordant partner is associated with increased safer sex intentions among HIV-positive men in Kathmandu, Nepal. J Health Popul Nutr. 2011;29(3):191–9.
Poudel KC, Poudel-Tandukar K, Yasuoka J, Joshi AB, Jimba M. Correlates of sharing injection equipment among male injecting drug users in Kathmandu, Nepal. Int J Drug Policy. 2010;21(6):507–10.
Disease Control and Prevention Centers. 2008 National Health Interview Survey Sample Adult Core Questionnaire. U.S. Department of Health and Human Services, CDC, Hyattsville, Md, USA, 2009, ftp://ftp.cdc.gov/pub/Health_Statistics/NCHS/Survey_Questionnaires/NHIS/2008/english/qadult.pdf.
Justice AC, Holmes W, Gifford AL, et al. Development and validation of a self-completed HIV symptom index. J Clin Epidemiol. 2001;54(Suppl 1):S77–90.
Kohrt BA, Kunz RD, Koirala NR, Sharma VD, Nepal MK. Validation of a Nepali version of the beck depression inventory. Nepal J Psychiatry. 2002;2:123–30.
Babiker A, Hassan M, Muhammed S, et al. Inflammatory and cardiovascular diseases biomarkers in chronic hepatitis C virus infection: a review. Clin Cardiol. 2020;43(3):222–34.
Reingold J, Wanke C, Kotler D, et al. Association of HIV infection and HIV/HCV coinfection with C-reactive protein levels: the fat redistribution and metabolic change in HIV infection (FRAM) study. J Acquir Immune Defic Syndr. 2008;48(2):142–8.
Pearson TA, Mensah GA, Alexander RW, et al. Markers of inflammation and cardiovascular disease: application to clinical and public health practice: a statement for healthcare professionals from the Centers for Disease Control and Prevention and the American Heart Association. Circulation. 2003;107(3):499–511.
Myers GL, Rifai N, Tracy RP, et al. CDC/AHA Workshop on Markers of Inflammation and Cardiovascular Disease: Application to Clinical and Public Health Practice: report from the laboratory science discussion group. Circulation. 2004;110(25):e545–549.
Shiels MS, Katki HA, Freedman ND, et al. Cigarette smoking and variations in systemic immune and inflammation markers. J Natl Cancer Inst. 2014;106:11.
Taylor DH Jr, Hasselblad V, Henley SJ, Thun MJ, Sloan FA. Benefits of smoking cessation for longevity. Am J Public Health. 2002;92(6):990–6.
Hughes JR, Keely J, Naud S. Shape of the relapse curve and long-term abstinence among untreated smokers. Addiction. 2004;99(1):29–38.
Poudel KC, Fujita M, Green K, Poudel-Tandukar K, Jimba M. Non-communicable diseases in southeast Asia. Lancet. 2011;377(9782):2004–5.
O'Loughlin J, Lambert M, Karp I, et al. Association between cigarette smoking and C-reactive protein in a representative, population-based sample of adolescents. Nicotine Tob Res. 2008;10(3):525–32.
Kianoush S, Yakoob MY, Al-Rifai M, et al. Associations of cigarette smoking with subclinical inflammation and atherosclerosis: ELSA-Brasil (The Brazilian Longitudinal Study of Adult Health). J Am Heart Assoc. 2017;6:6.
Patrick DL, Cheadle A, Thompson DC, Diehr P, Koepsell T, Kinne S. The validity of self-reported smoking: a review and meta-analysis. Am J Public Health. 1994;84(7):1086–93.
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.
Conflict of interest
We declare that we have no conflict of interest.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
About this article
Cite this article
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). https://doi.org/10.1007/s10461-020-03048-0
- C-reactive protein