High smoking prevalence among HIV-positive individuals: a systematic review and meta-analysis

Background: Several observational and population-based studies to determine the prevalence of smoking among people living with HIV (PLWH) have been conducted in multiple settings. However, no study has conducted a meta-analysis of global studies of smoking prevalence among large samples of PLWH. Objectives: This study aimed to estimate the prevalence of smoking and characteristics associated with smoking among PLWH. Methods: Studies were included if conducted in HIV population, data available on current smoking, either cross-sectional or cohort study, and the minimum sample size was 1,000. A random-effects model was selected to summarize the prevalence of smoking. Sub-group analyses and meta-regression were performed to address heterogeneity. Results: A total of 31 articles from 2,763 studies were included. The estimated prevalence of current smoking was 46.5% (95%CI: 40.9–52.1) and the pooled prevalence of former smokers was 22.4%. The highest current smoking prevalence was found in European countries (46.4%), males (75.9%), and men who have sex with men (MSM) (52.1%). Conclusion: Nearly half of the people living with HIV were smokers, and this figure was higher in European countries, among males and MSM. It is critical to encourage more effective efforts toward smoking cessation among PLWH.