摘要：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. HIV-positive women in the United States tend to be from lower socioeconomic strata in which smoking is common, and its adverse effects add to the burdens of HIV infection and poverty. 1 Other articles have suggested that smoking may modify CD4+ lymphocyte counts, but findings have not consistently established a relation between smoking and the course of HIV/AIDS. 2 – 5 In the Multicenter AIDS Cohort Study, no association was found between smoking and the risk of developing AIDS or dying, but the study included only gay men of middle and upper socioeconomic status. 6 Also missing from this report were data on viral load, and the study was conducted before the use of highly active antiretroviral therapy (HAART) became widespread. We therefore conducted a study taking advantage of a longitudinal data set of HIV-infected women whose smoking status, viral load status, immune status, and antiretroviral use were well documented. To our knowledge, no previous studies have assessed the association of smoking with response to HAART.
