Global burden of active smoking among people living with HIV on antiretroviral therapy: a systematic review and meta-analysis

Abstract

Background Although the high burden of both active smoking and human immunodeficiency virus (HIV) is clearly known, the relationship between them is still not well characterized. Therefore, we estimated the global prevalence of active smoking in people living with HIV (PLHIV) on antiretroviral therapy (ART) and investigated the association between exposure to active smoking and risk for suboptimal adherence to ART. Main text: We searched PubMed, Embase, and Web of Science to identify articles published until September 19, 2019. Eligible studies reported the prevalence of active smoking in PLHIV on ART or investigated the association between active smoking and ART adherence; or enough data to compute these estimates. We used a random-effects model to pool data and quantified heterogeneity (I2). The global prevalence of active smoking was 36.1% (95% CI: 33.7–37.2; 329 prevalence data; 462 104 participants) with substantial heterogeneity. The prevalence increased with level of country income; from 10.1% (95% CI: 6.8–14.1) in low-income to 45.2% (95% CI: 42.7–47.7) in high-income countries; P < 0.0001. With regards to the Joint United Nations Programme on HIV/AIDS (UNAIDS) regions, the prevalence was higher in West and Central Europe and North America 45.4% (42.7–48.1) and lowest in the two UNAIDS regions of sub-Saharan Africa: Eastern and Southern Africa 10.7% (95% CI: 7.8–14.0) and West and Central Africa 4.4% (2.9–6.3); P < 0.0001. Globally, we estimated that there were 4 110 669 PLHIV on ART who were active smokers, among which the highest number was from Eastern and Southern Africa (35.9%) followed by Asia and the Pacific (25.9%). Active smoking was significantly associated with suboptimal ART adherence: pooled odds ratio 1.57 (95% CI: 1.37–1.80; I2 = 56.8%; 19 studies; 48 450 participants); even after considering adjusted estimates: 1.67 (95% CI: 1.39–2.01; I2 = 53.0%; 14 studies). Conclusions This study suggests a high prevalence of active smoking in PLHIV on ART and an association between active smoking and ART suboptimal adherence. As such, healthcare providers and policy makers should focus on adopting and implementing tobacco harm reduction strategies in HIV care, especially in sub-Saharan Africa known as epicenter of HIV pandemic with highest number of active tobacco smoking among PLHIV on ART.

Metabolic syndrome in people with HIV from Guatemala: analysis of components and risk factors

“…Prior research has highlighted that the risk factors related to metabolic syndrome (highcalorie intake, sedentarism, smoking, alcohol use) are more common among urban populations 44 and in PWH. 45,46 Considering that Central America is one of the fastest urbanizing regions in the world and Guatemala has the highest urban population growth in the Central American region (3.4% per year) it is imperative that public health interventions involve the promotion of cardiovascular health in urbanized areas to prevent metabolic syndrome at a community level. 47 Another important lifestyle risk factor found statistically significant in our study was low physical activity.…”

“…A total of 844 participants were included in this analysis. Median age was 39 years [interquartile rage (IQR) [31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46][47][48], 479 were male (56.8%), and 139 (16.5%) selfidentified with indigenous ethnicity. Primary education or below was reported by 459 participants (54.3%) and 70.8% were urban dwellers (598).…”

Cartilha para estilo de vida saudável em pessoas com HIV: ensaio clínico

“…(26) Revisão sistemática também demonstrou que mais de um terço das PVHIV são tabagistas, e portanto, expostas à substâncias que contribuem para a ocorrência de doenças cardiovasculares, respiratórias e cânceres. (32) Ademais, o uso de drogas aumenta os comportamentos de risco e transmissão do HIV, de forma que a cartilha recomenda não utilizá-las, assim como estimula a busca de assistência especializada, se necessário. (10) O quinto domínio da cartilha foi sobre o controle do estresse.…”

HIV and chronic lung disease

“…In the United States, for example, approximately 60-70% of PLWH are either current or former smokers, twice the prevalence found in the HIV-uninfected population [6,7]. Although active smoking prevalence is considerably lower in PLWH from Africa, Asia, Latin America, and the Caribbean compared to North America and Europe [8], these rates similarly still exceed background population rates [9]. Fortunately, smoking prevalence appears to be declining at least in the United States [6,[10][11][12][13] and Canada [14], but the full impact that smoking cessation will have on chronic lung disease incidence has yet to be determined.…”