People with HIV are more likely to smoke than healthy people. Smoking can interfere with normal lung function in healthy people. In people with HIV, smoking can make it more difficult to fight off serious infections.

People with HIV are now living longer. Smoking and related problems can interfere with long term quality of life. Recent studies show that smokers with HIV lose more years of life from smoking than from HIV.


Smoking weakens the immune system. It can make it harder to fight off HIV-related infections. This is especially true for infections related to the lungs. This is a risk for smoking marijuana as well as tobacco. Having HIV increases the risk of chronic lung disease.

Smoking can interfere with processing of medications by the liver. It can also worsen liver problems like hepatitis.

Smoking and Side Effects

People with HIV who smoke are more likely to suffer complications from antiretroviral medications (ARVs) than those who don’t. For example, those who smoke are more likely to experience nausea and vomiting from taking ARVs.

Smoking increases the risk of some long-term side effects of HIV disease and treatment. These include osteoporosis (weak bones that can lead to fractures) and osteonecrosis (bone death). HIV treatment slightly increases the risk of heart attack, but smoking is the major controllable risk factor for cardiovascular disease (CVD), which can lead to heart attack and stroke.

Recent studies found that quitting smoking reduced heart attack risk in people with HIV more than other factors such as changes in medications.

Smoking and Opportunistic Infections

People with HIV disease who smoke are more likely to develop several opportunistic infections (OIs) related to HIV, including:

For people assigned female at birth (AFAB), smoking can increase the risk and severity of infection with human papilloma virus (HPV). This increases the risk of cervical disease.

The bacterium that causes Mycobacterium Avium Complex (MAC) has been linked to smoking. MAC bacteria were found in tobacco, cigarette paper, and filters even after they had been burned.

Smoking and Risk of Death

A recent study found that smoking among people with HIV was linked to a higher rate of death. This was true for current smokers and ex-smokers. The greatest increase in the risk of death (60%) was for CVD and some cancers.


Smoking (nicotine) is highly addictive. It is very difficult to stop smoking. There is no one way to quit smoking. Different methods of quitting work better for different people. You and your healthcare provider can develop a combination of approaches that work best for you.

Some people quit smoking cold turkey. That is, they just stop smoking. Other people need some kind of support. This can be from medications that manage the physical symptoms of withdrawal or therapies that deal with the psychological addiction to smoking.

Nicotine withdrawal can be treated with medications. Some are available over the counter (OTC), while others require a prescription. Gums and lozenges that reduce nicotine cravings are often available OTC. Prescription medications include inhalers, nasal sprays, and pills. All these treat the physical and chemical symptoms of withdrawal.

Some people also get help to quit smoking by:

    • Altering the routines that encourage them to smoke
    • Getting support to reduce outside factors like stress that encourage them to smoke
    • Participating in motivational groups

Some people have good success with alternative treatments like acupuncture, hypnosis, and biofeedback.


For people with HIV, smoking can reduce the immune system’s capabilities to fight infections. Smoking has more of a negative effect on life span and overall health than HIV.

There are many ways to quit smoking. You and your healthcare provider can discuss the ways that will work best for you. 


American Lung Association or (800) LUNG-USA

American Cancer Society: Great American Smoke Out

Quit Assist


U.S. Health and Human Services: Health Consequences of Smoking, Surgeon General fact sheet

Reviewed March 2021

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