The Positive Side

Spring/Summer 2004 

Up in Smoke

The ifs, ands or buts of butting out.

By Andrea Rudd

HAVE YOU EVER NOTICED how many HIV positive people smoke? I’m always amazed when I go to events in the community and see people puffing away outside. Don’t they know that smoking kills 45,000 Canadians each year — three times more than car accidents, suicides, murder and AIDS combined?!

I’m not one to judge. As an ex-smoker, I remember the habit fondly. I started around the age of 15 and smoked for 14 years, quitting in 1988, just before my HIV diagnosis. I rolled my own cigarettes. I liked the ritual of it and I thought it looked cool to smoke. So I understand well the attraction and comfort — and addictive nature — of cigarettes.

If you’re well aware that smoking has many long-term health risks, like: heart disease, emphysema, lung and other cancers (throat, pancreatic, stomach, breast, cervical, anal), gum disease and osteoporosis — as many as one out of every two long-term smokers will die from a tobacco-related illness, according to the Canadian Cancer Society…

And you know that smoking can worsen certain problems and illnesses that people with HIV/AIDS (PHAs) are already vulnerable to, such as lung and heart disease, gum and bone problems…

Did you know that, in addition to all that, smoking may weaken your body’s response to highly active antiretroviral therapy (HAART)? University of Miami researchers found that HIV positive smokers’ response to HAART decreased by about 40% as measured through drug levels in the body, CD4 counts and viral loads.

HIV certainly puts a lot on our plate: fear, depression, discrimination, illness, poverty, side effects… to list just a few things.

But rationalizing an unhealthy habit with an excuse like “I already have HIV, smoking is the least of my concerns,” just doesn’t cut it. Here are some more reasons why:

Have a heart

Many of us are living longer thanks to HAART. But as we enter middle age, the risk of heart disease increases. In addition, HAART can hurt your heart, as protease inhibitors elevate lipid (fat) levels — cholesterol and triglycerides — in the blood. Adding smoking to the mix further compounds cardiac concerns.

Breathe deeply

The risk of developing pneumonia and tuberculosis, as well as emphysema, Mycobacterium avium complex (MAC) and other lung diseases is significantly higher in smokers with HIV than smokers without. One study found that lung cancer is about eight times more prevalent in PHAs than in our negative counterparts. Long-term viral suppression doesn’t completely restore the immune system, and a compromised immune system is more susceptible to cancers. HIV positive smokers are developing lung cancer at a much younger age than smokers in the general population.

Stay nourished

Due to high rates of human papilloma virus (HPV) infection among PHAs, we’re at increased risk for anogenital cancers. HPV is associated with most genital warts and lesions, and smoking inflates the risk that HPV will develop into cervical or anal cancer. The progression of these lesions and cancers is also associated with other co-factors, such as a weak immune system and poor nutrition. Deficiencies in vitamin C and other nutrients are linked with cancer progression. Studies have shown that smoking significantly reduces the body’s store of vitamin C. It also takes a toll on the immune system by killing Langerhan cells, which fight off viral infections like HPV.

Get it up

For many smokers, there’s nothing like lighting up after making love. But here’s something not so sexy about smoking: Men who smoke often have weaker erections. Smoking contributes to the accumulation of fatty deposits in the arteries and veins, which can reduce blood flow to the penis. Also, the build-up of nicotine in the tissue of the penis may make it difficult to keep an erection.

Be good to your bone

Many antiretrovirals cause osteopenia (bone loss) and osteoporosis (severe bone loss), which can lead to fractures and broken bones. Smokers tend to have lower bone mass. You do the math.

Having a baby

Smoking during pregnancy increases the possibility of transmitting HIV to your baby, according to researchers in Philadelphia. Nicotine and other chemicals in cigarettes can rupture the membranes surrounding the baby, increasing its exposure to blood and other secretions. Babies born to moms who puff often have problems such as low birth weight, asthma, chronic ear infections, learning disabilities and behavioural problems.

Blowing smoke

Smokers expose everyone around them to the 4,000 chemicals packed into their butts, including 50 cancer-causing substances such as arsenic, ammonia, carbon monoxide, cyanide, lead, mercury and nicotine. Second-hand smoke from the burning end of a cigarette is highly concentrated with these toxicities.

Reach out

Because smoking is such a powerful addiction, quitting isn’t always easy. It requires inner strength, willpower, patience and support. For many people, becoming a non-smoker is a process. You may need to make several attempts before you finally kick the habit — it took me about five tries. I dealt with withdrawal symptoms by going to aerobics class every day for the first few months and taking extra B-complex vitamins to help me deal with stress. Over time, my craving lessened.

While I was eventually able to quit cold turkey, some people prefer to gradually taper off by decreasing the number of cigarettes smoked per day. When stress is high, it may not be a good time to stop cold turkey. Self-caring de-stressors such as exercise, yoga or massage can help ease withdrawal.

Cigarette addiction is 95% psychological and 5% physiological. Most nicotine is eliminated from your body in about one week. Any cravings to smoke after that aren’t from nicotine withdrawal but from psychological stressors and behavioural patterns. So, it may help to keep a diary of your smoking habits (when you light up, how you feel) to track what “triggers” you to smoke. Then focus on avoiding or undoing these triggers (cut out that morning coffee or switch to tea). Another idea is to set limits to your smoking boundaries (no smoking in the house or after dinner).

Ask your health care provider for support and suggestions. Here are a few:

  • Check out the Canadian Cancer Society.
  • Join a support group, in person or online. You’re not alone. At, about 400 people are online at any given time. One night a woman posted a note asking for help as she held a cigarette in her hand, about to light up. Within a minute, a half-dozen people replied with tips on how to curb the craving.
  • Put on the patch or chew nicotine gum.
  • Ask your doc about the prescription pill Zyban (and about which HIV drugs it interacts with).
  • Try acupuncture or acupressure (shiatsu).
  • Look into hypnosis, behavioral interventions and special vitamin regimens.
  • Click on Health Canada for more info.
Andrea Rudd works for various AIDS organizations in Ontario. She’d like to assure positive smokers who are considering butting out that the benefits are well worth the effort.

Smoke-Free: Things to look forward to

After a few days: Taste and smell improve
After a few weeks: Circulation improves
After one year: Risk of heart disease is cut by half
After a few years: Risk of heart disease is the same as someone who never smoked
After 10 years: Risk of lung cancer is cut in half

Extra nutritional support for smokers

PHAs have special nutritional needs. Smoking further depletes your body’s supply of many essential vitamins and minerals, particularly antioxidants. Extra amounts of the following nutrients can be taken to support your health. Consult a naturopathic doctor or nutritionist for specific advice.

vitamin C
vitamin E
B complex
beta carotene