EVALI and HIV: Is it time to stop vaping?

by Ann K. Avery, MD

By: Ann K. Avery, MD, Infectious Disease Physician at MetroHealth Medical Center

People smoke. It’s just one of those realities of life, like drinking or other recreational drugs. Everyone can make their own choices, but it’s important that we can find the information we need to make informed decisions about what we put into our bodies, from the food we eat to the tobacco we smoke.

So, while it’s common knowledge that cigarettes aren’t exactly the best for you, when e-cigarettes came out there was this hope that we finally had a decent alternative to normal cigarettes. It surely couldn’t be as bad as the original, right? But we were just assuming, we weren’t sure of the effects yet.

Today we have information about the effects of vaping, like EVALI (which stands for e-cigarette or vaping use-associated lung injury). And that’s good news, because it means you can make decisions about your body, armed to the teeth with knowledge!

What you do with that information is totally up to you, and we support you no matter what. Still, it’s necessary to get rid of the smoke and mirrors around e-cigarettes and figure it all out together.

The side effects of vaping

EVALI was originally known as VAPI (vaping associated pulmonary illness). The name was changed because of the growing number of severe lung illness cases from e-cigarette and vaping products.

We’re still learning about EVALI, and there’s no single test for it. At the moment, diagnosis is done by going through the list of other lung problems before landing on EVALI, because so many of the symptoms overlap. Some of these include:

  • Fever and chills
  • Chest pain
  • Shortness of breath
  • Rapid heart rate
  • Cough
  • Vomiting
  • Diarrhea
  • Headaches and dizziness

Since EVALI is still pretty new, experts are hard at work to understand what sorts of treatment options there are. Your doctor will take your vaping history into account; and they might order a chest x-ray or CT scan to get a clearer picture of what’s going on. At this point, it’s difficult to predict how the illness might progress.

How bad are we talking, here?

We won’t sugarcoat it: the news is E-cigarettes aren’t good for you, especially if you are living with HIV.

This is because of the many chemicals inhaled when vaping, causing a wide range of issues like EVALI. Here’s a few of the chemicals:

  • Diacetyl: Used in more than 60% of sweet-flavored vapes, diacetyl is the same chemical that gives food a buttery or creamy flavor. You may have heard of the effects of diacetyl by the name of popcorn lung. This condition is one part of EVALI; it also affects factory workers who are exposed to high levels of diacetyl in the workplace. Just three to four puffs on a vape a day exceeds OSHA diacetyl exposure limits.
  • Acrolein: More commonly used to fight algae, weeds, bacteria, and mollusks, acrolein also causes damage to people’s lungs.
  • Formaldehyde: You’ve probably heard of formaldehyde in the context of pesticides, building materials, and even preservatives. It’s a colorless, toxic, flammable substance, with repeated exposure possibly leading to lung disease and heart disease, as well as cancer.

You can, of course, take a deeper dive here, but we think you get the picture!

Heating ingredients to create vapor also causes their chemical components to break down, exposing smokers to carcinogens and other chemicals. The refillable cartridges similarly heat up, causing the heating coils to decompose. Basically, smoking an e-cigarette can be kind of like inhaling or ingesting toxic metals. The unfortunate reality is that e-cigarettes can cause some serious harm to your lungs and body.

Where does HIV come in?

The reason this might matter even more for people living with HIV is because lung cancer is a common cancer for people living with HIV. The risk of lung cancer is estimated to be 2-7 times higher for people with HIV.

This means that lung cancer has emerged as a leading cause of death for people with HIV, especially for those who smoke. While treatment is possible, it’s also long, complicated, and oftentimes painful. Once again, experts are working on finding solutions, but the best thing you can do to avoid EVALI is vape less often, or even better, don’t vape at all. Easier said than done, we know! We’ll get into this in the last section.

Why do people still use e-cigarettes?

We’ve seen e-cigarette use pretty much explode in recent years, especially among young adults. Rates in high school seniors went from nearly zero in 2011 to almost 29% in 2019, according to the Center for Disease Control and Prevention (CDC). It’s been so confusing to figure out what exactly is in e-cigarettes and what their effects are that some teens aren’t even aware they are vaping nicotine!

Marketing is partly to blame here, with ads and product information saying that e-cigarettes are safer than cigarettes. Even if that is true, we can clearly see there are still major issues with vaping that can cause life-threatening harm.

Remember, we absolutely support you reducing e-cigarette use, or even better, not using them at all! Now that we know more about EVALI, it might sound like vaping is worse than cigarette smoking, but regular ole’ cigarettes have their own mountain of health effects. If you stop or cut down on vaping, it probably isn’t a good idea to replace the vaping with smoking regular cigarettes. Similar names, similar chemicals, and each is risky in their own way.

It’s up to all of us to help educate others on the very real possibility of diseases like Popcorn Lung, Lipoid Pneumonia, Collapsed Lung, and EVALI. One place to get accurate information is from the Positive Peers app, where you can get medical advice and speak to other people living with HIV, working through the same challenges. Together, we can help one another decide if vaping is something we want to continue, or instead, find ways to quit.