Tobacco and HIV: health issues and benefits of quitting

Among people living with HIV, smoking remains a major cause of preventable morbidity and mortality. Despite the considerable progress made possible by antiretroviral treatments, tobacco use continues to impair the health, life expectancy, and quality of life of this population. Smoking cessation is a crucial tool for reducing associated complications and improving the overall effectiveness of HIV care.

A particularly high prevalence of smoking

Tobacco use is significantly more common among people living with HIV than in the general population. Available data indicate a prevalence that may be two to three times higher, reflecting an increased vulnerability to nicotine addiction. This overrepresentation is explained by multiple factors, including social determinants of health, the psychosocial burden associated with the diagnosis, and the higher frequency of certain comorbidities.

This prolonged exposure to tobacco has major health consequences. HIV-positive individuals who smoke have an increased risk of cardiovascular disease, tobacco-related cancers, chronic respiratory diseases, and lung infections. In contexts where access to antiretroviral treatments is optimal, smoking now appears to be one of the main factors limiting gains in life expectancy, potentially having an impact comparable to, or even greater than, that of HIV itself.

Negative interactions with the immune system and treatments

Smoking has well-documented detrimental effects on the immune system, effects that are particularly significant for people living with HIV. It is associated with increased chronic inflammation and impaired immune defense mechanisms, especially in cells involved in the immune response. These disruptions can increase vulnerability to opportunistic infections and contribute to a more rapid decline in overall health.

These effects occur within a context already marked by HIV infection, which directly targets certain key cells of the immune system. Smoking thus reinforces persistent inflammatory processes, now recognized as a major determinant of non-AIDS-related comorbidities, such as cardiovascular diseases, certain cancers, and chronic lung diseases. This low-grade inflammation, perpetuated by tobacco, is likely to limit the long-term benefits of antiretroviral treatments, even when the viral load is controlled.

Furthermore, tobacco use is associated with increased difficulties in adhering to treatment. People living with HIV who smoke more frequently experience problems with treatment adherence and less regular use of medical monitoring services. These factors can compromise the maintenance of an undetectable viral load and jeopardize the overall effectiveness of long-term care.[1].

Stopping nicotine use, a central lever in the overall management of HIV

Smoking cessation is a major factor in improving the health of people living with HIV. The observed benefits are both rapid and lasting, and affect several dimensions of health. Physiologically, cessation is accompanied by, in particular, an improvement in respiratory function and a progressive reduction in cardiovascular risk, which is particularly high in this population. Positive effects on immune balance have also been reported, contributing to better overall health.

In the medium and long term, quitting smoking significantly reduces the incidence of tobacco-related cancers, chronic lung diseases, and cardiovascular events, which currently account for a significant portion of morbidity and mortality among people living with HIV. These benefits are accompanied by an improved quality of life, with a reduction in shortness of breath, fatigue, and certain psychological symptoms associated with nicotine addiction.

In this context, smoking cessation is essential as a cornerstone of comprehensive HIV care, alongside virological and immunological monitoring. Health authorities recommend the systematic integration of smoking cessation support into care pathways, based on an approach combining behavioral support and validated withdrawal aids.[2]. Such integration helps to consolidate the effectiveness of antiretroviral treatments, to secure long-term monitoring and to optimize the benefits of therapeutic advances.

Beyond the individual clinical challenge, smoking cessation among people living with HIV is part of a broader public health perspective and a drive to reduce inequalities. By addressing a preventable risk factor, it is possible to sustainably improve life expectancy and quality of life, while strengthening the coherence of HIV prevention and care policies.

©Generation Without Tobacco

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[1] How Does Smoking Affect People with HIV?, HIV.gov, updated September 18, 2025

[2] How quitting nicotine can benefit people living with HIV, Truth Initiative, published on December 15, 2025, accessed the same day