Date of Award

Fall 2011

Degree Type


Degree Name

Doctor of Philosophy (PhD)


Health Research Methodology


Marek Jozef Smieja


Lehana Thabane



Committee Member

Andrew McIvor, Fiona Smaill


Cigarette smoking is prevalent in HIV-infected people, resulting in higher mortality rate and more premature heart and lung diseases in the highly active antiretroviral therapy era. Smoking is a modifiable risk factor for these adverse outcomes and smoking cessation in HIV-positive smokers is feasible, although further efforts are needed to improve smoking cessation programs in HIV-positive persons.

In this thesis, I examined the role of smoking in mortality and morbidity in HIV-positive Ontarians, and piloted a smoking cessation program featuring a novel smoking cessation aid, varenicline, in HIV-infected smokers. In addition, I explored three different methods to resolve missing data, by excluding, grouping and multiply imputing missing data. I adopted three different study designs in my thesis studies: retrospective cohort, cross-sectional and open label study.

We found smoking prevalence in HIV-infected people was consistently higher than in the general population. Smoking was associated with a higher risk of death, of respiratory symptoms, hospitalization and chronic obstructive pulmonary disease, and with reduced lung function and less CD4-T-lymphocyte improvement over time. We found varenicline was as effective in HIV-positive smokers as in non-HIV smokers reported by previous studies.

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