People living with HIV (PLWH) in the antiretroviral therapy (ART) era may lose more life-years to tobacco use than to HIV. Yet, smoking rates are more than twice as high among PLWH than the general population, contributing not just to mortality but to other adverse health outcomes, including neurocognitive deficits (neuroHIV). There is growing evidence that synergy with chronic inflammation and immune dysregulation that persists despite ART may be one mechanism by which tobacco smoking contributes to neuroHIV. This review will summarize the differential effects of nicotine vs tobacco smoking on inflammation in addition to the effects of tobacco smoke components on HIV disease progression. We will also discuss biomarkers of inflammation via neuroimaging as well as biomarkers of nicotine dependence (e.g., nicotine metabolite ratio). Tobacco smoking and nicotine may impact ART drug metabolism and conversely, certain ARTs may impact nicotine metabolism. Thus, we will review these bidirectional relationships and how they may contribute to neuroHIV and other adverse outcomes. We will also discuss the effects of tobacco use on the interaction between peripheral organs (lungs, heart, kidney) and subsequent CNS function in the context of HIV. Lastly, given the dramatic rise in the use of electronic nicotine delivery systems, we will discuss the implications of vaping on these processes. Despite the growing recognition of the importance of addressing tobacco use among PLWH, more research is necessary at both the preclinical and clinical level to disentangle the potentially synergistic effects of tobacco use, nicotine, HIV, cognition and immune dysregulation, as well as identify optimal approaches to reduce tobacco use.

在抗逆转录病毒疗法 (ART) 时代，艾滋病毒感染者 (PLWH) 可能因烟草使用而损失的生命年数可能多于艾滋病毒。然而，PLWH 的吸烟率是一般人群的两倍多，这不仅会导致死亡率，还会导致其他不良健康结果，包括神经认知缺陷 (neuroHIV)。越来越多的证据表明，尽管接受了 ART，但与慢性炎症和免疫失调的协同作用可能是吸烟导致神经 HIV 的一种机制。除了烟草烟雾成分对 HIV 疾病进展的影响之外，本综述还将总结尼古丁与烟草吸烟对炎症的不同影响。我们还将通过神经影像学讨论炎症的生物标志物以及尼古丁依赖的生物标志物（例如，尼古丁代谢物比率）。吸烟和尼古丁可能会影响 ART 药物代谢，相反，某些 ART 可能会影响尼古丁代谢。因此，我们将审查这些双向关系以及它们如何导致神经 HIV 和其他不良后果。我们还将讨论烟草使用对 HIV 背景下外周器官（肺、心脏、肾脏）和随后的 CNS 功能之间相互作用的影响。最后，鉴于电子尼古丁输送系统的使用急剧增加，我们将讨论电子烟对这些过程的影响。尽管人们越来越认识到解决 PLWH 中烟草使用问题的重要性，但需要在临床前和临床层面进行更多研究，以解开烟草使用、尼古丁、艾滋病毒、认知和免疫失调的潜在协同效应，