Global burden of active smoking among people living with HIV on antiretroviral therapy: a systematic review and meta-analysis
Infectious Diseases of Poverty·
- DOI
- 10.1186/s40249-021-00799-3
- PMID
- 33579391
- PMCID
- PMC7881452
- OpenAlex
- W3129072501
- Study type
- Systematic review
- Publisher
- Springer Science and Business Media LLC
- Article type
- journal-article
- Integrity
- current
Why this research matters now
The authors highlight a high prevalence of active smoking in PLHIV on ART and suggest that healthcare providers and policy makers consider tobacco harm reduction strategies within HIV care, with particular attention to sub-Saharan Africa.
Structured evidence summary
Research question
The review sought to estimate the global prevalence of active smoking among people living with HIV who are on antiretroviral therapy and to examine whether active smoking is associated with suboptimal adherence to ART.
Study design
A systematic review and meta-analysis searching PubMed, Embase, and Web of Science for articles published through September 19, 2019, pooling data with a random-effects model and quantifying heterogeneity via I².
Population and setting
People living with HIV on antiretroviral therapy worldwide, with prevalence stratified by country income level and by UNAIDS regions.
Main findings
The pooled global prevalence of active smoking among PLHIV on ART was 36.1% (95% CI 33.7–37.2; 329 prevalence datapoints; 462,104 participants) with substantial heterogeneity. Prevalence rose with country income level, from 10.1% in low-income to 45.2% in high-income countries, and varied across UNAIDS regions, ranging from about 4.4% in West and Central Africa to 45.4% in West and Central Europe and North America. An estimated 4,110,669 PLHIV on ART were active smokers globally, with the largest share from Eastern and Southern Africa. Active smoking was associated with suboptimal ART adherence (pooled OR 1.57, 95% CI 1.37–1.80; 1.67 after restriction to adjusted estimates).
Public-health relevance
The authors highlight a high prevalence of active smoking in PLHIV on ART and suggest that healthcare providers and policy makers consider tobacco harm reduction strategies within HIV care, with particular attention to sub-Saharan Africa.
Important limitations
The authors note substantial heterogeneity across prevalence estimates. This summary is additionally limited to the supplied single-article abstract and metadata and does not include the full paper, so decision-grade interpretation requires the original article.
GIDS interpretation
The paper is discoverable through disease and topic classifiers relevant to HIV/AIDS, treatment, and health policy, and it provides contextual evidence on smoking burden in PLHIV on ART. It is not itself a surveillance signal, and no connection to a live surveillance signal can be inferred from the supplied evidence.
Related GIDS surveillance
Literature context does not validate, explain, or change a surveillance signal. Exact and contextual relationships are shown separately.
Evidence relationships
This article has 9 auditable classifier relationships to diseases, places, topics, and study design.