Worldwide relative smoking prevalence among people living with and without HIV: a systematic review and meta-analysis

Johnston, Peter I.; Wright, Shanie W.; Orr, Martin; Pearce, Fiona A.; Stevens, John W.; Hubbard, Richard B.; Collini, Paul J.

Abstract

Objective and design: People living with HIV (PLH) suffer disproportionately from the chronic diseases exacerbated by smoking tobacco. We performed a systematic review and meta-analysis to establish the relative prevalence of smoking among PLH.

Methods: We included observational studies reporting current smoking rates among PLH and comparators without HIV. We searched Medline, EMBASE, LILACS and SciELO from inception to 31.08.19. We excluded studies that recruited participants with smoking related illness. We used a random effects model to estimate the odds ratio for current smoking in PLH and people without HIV. We used the Newcastle-Ottawa scale to assess methodological bias.
We performed subgroup analysis based on gender and World Health Organization (WHO) region. We quantified heterogeneity with meta-regression and predictive distributions.
PROSPERO registration:CRD42016052608.

Results: We identified 6116 studies and included 37. Of 111,258 PLH compared with 10,961,217 HIV negative participants pooled odds of smoking were 1.64 ((95% CI: 1.45-1.85)(95% PI: 0.66
4.10, I2 98.1%)). Odds for men and women living with HIV were 1.68 ((95% CI: 1.44-1.95)(95% PI: 0.71-3.98, I2 91.1%)) and 2.16 ((95% CI: 1.77-2.63)(95% PI: 0.92-5.07, I2 81.7%)) respectively.

Conclusions: PLH are more likely to be smokers than people without HIV. This finding was true in sub-group analyses of males, females and in four of five WHO regions from which data were available.

Meta-regression did not explain heterogeneity, which we attribute to the diversity of PLH populations worldwide. Smoking is a barrier to PLH achieving parity in life expectancy and an important co-variate in studies of HIV associated multi-morbidity.

Citation

Johnston, P. I., Wright, S. W., Orr, M., Pearce, F. A., Stevens, J. W., Hubbard, R. B., & Collini, P. J. (2021). Worldwide relative smoking prevalence among people living with and without HIV: a systematic review and meta-analysis. AIDS, 35(6), 957-970. https://doi.org/10.1097/QAD.0000000000002815

• Journal Article Type: Article
• Acceptance Date: Sep 28, 2020
• Online Publication Date: Jan 18, 2021
• Publication Date: May 1, 2021
• Deposit Date: Oct 2, 2020
• Publicly Available Date: Jan 19, 2022
• Journal: AIDS
• Print ISSN: 0269-9370
• Electronic ISSN: 1473-5571
• Publisher: Lippincott, Williams & Wilkins
• Peer Reviewed: Peer Reviewed
• Volume: 35
• Issue: 6
• Pages: 957-970
• DOI: https://doi.org/10.1097/QAD.0000000000002815
• Public URL: https://nottingham-repository.worktribe.com/output/4936907
• Publisher URL: https://journals.lww.com/aidsonline/Abstract/9000/Worldwide_relative_smoking_prevalence_among_people.96505.aspx