HIV-positive Americans are more likely to smoke and less likely to quit than the general population.

Centers for Disease Control and Prevention (CDC) researchers analyzed data on 4,217 HIV-positive and 27,731 HIV-negative adults. They estimated that out of the 420,000 HIV-positive Americans receiving care for the virus today, 42 percent smoke, 20 percent used to smoke, and 37 percent never smoked. Compared with the 21 percent smoking rate in the general population, people with HIV are twice as likely to smoke. And while just 32 percent of HIV-positive people who have ever smoked have quit, 52 percent of ever-smokers in the general population have done so.

Factors that the researchers found to be independently associated with a greater likelihood of smoking among the HIV-positive population were older age, white or black (as opposed to Latino) race, less education, poverty, homelessness, imprisonment, substance use, binge drinking, depression and having a detectable viral load.

“We know that smoking is especially dangerous for the health of persons living with HIV, with increased risk for heart attacks, strokes and some cancers,” says Madeline Y. Sutton, MD, MPH, a medical epidemiologist at the CDC’s Division of HIV/AIDS Prevention and a coauthor of the study. “After controlling HIV infection by engaging patients in ongoing effective care, smoking cessation is the next intervention that will prevent the most illness, save the most lives and reduce the most costs associated with HIV infection.”