Tobacco is a legal and widely used drug. However, smoking is addictive and it can severely damage health and cause early death.

Smoking itself does not make HIV infection worse. HIV treatment is just as effective in smokers as non-smokers.

However, people with HIV who smoke are more likely to get certain infections and AIDS-defining illnesses, particularly those affecting the chest, such as the AIDS-defining pneumonia PCP. Oral thrush, a common complaint in people with HIV, is also more common amongst smokers. Emphysema, a smoking-related illness, is much more common in people who smoke and have HIV, compared to smokers without HIV.

Smoking increases the risk of heart disease, high blood pressure and stroke. It’s thought that having a long-term illness like HIV might increase the risk of heart disease. Some anti-HIV drugs can cause increases in blood fats (lipids), and this can contribute to cardiovascular illnesses. If you smoke and take anti-HIV drugs, then your risks might be increased even further.

Smoking increases the risk of lung cancer. Although relatively rare, lung cancer seems to occur more often in people with HIV, even if they are taking anti-HIV drugs and have a well-controlled viral load.

Stopping smoking (or not starting in the first place) will significantly reduce your risk of developing heart disease and other illnesses. You are most likely to stop smoking and stay stopped if you are motivated.

There is a lot of help and support available if you would like to give up smoking. Your HIV clinic or GP can give you advice and support, and may also run groups for people who want to stop smoking.

Cigarettes are addictive because they contain nicotine. Many people find that nicotine replacement therapy can help reduce the craving for cigarettes and make quitting easier. Your doctor may be able to prescribe patches, gum, or lozenges that contain nicotine. There is no evidence that these interact with anti-HIV drugs. You can buy all of them over the counter.

Two drugs can be prescribed to help people give up smoking: bupropion (Zyban) and varenicline (Champix). Zyban interacts with anti-HIV drugs in the protease inhibitor and NNRTI classes, leading to an increase in the amount of Zyban in the blood. Make sure you tell your HIV doctor if you are thinking about taking Zyban. The drug can also cause side-effects, including dry mouth, insomnia, headaches and fits. Champix does not interact with anti-HIV drugs, It can cause the side-effect of mild nausea.

Many people find that alternative therapies, such as acupuncture and hypnotherapy, help them stop smoking. Exercise can also be helpful.

There’s more information on giving up smoking on the NHS Choices website.
 

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