Behavioral interventions for tobacco use in HIV-infected smokers: systematic review and pairwise, network meta-analysis of randomized trials
Xinyu Huang 1, Junjie Ren 1, Liying Zhou 1, Xu Hui 2, Liping Guo 2, Li Xu 3, Kehu Yang 2
1 Centre for Evidence-Based Social Science/Center for Health Technology Assessment, School of Public Health, Lanzhou University; Centre for Evidence-Based Medicine, School of Basic Medical Sciences, Lanzhou University; Gansu Key Laboratory of Evidence-Based Medicine, Lanzhou University; Lanzhou, Gansu, China; 2 Centre for Evidence-Based Medicine, School of Basic Medical Sciences, Lanzhou University; Gansu Key Laboratory of Evidence-Based Medicine, Lanzhou University; Lanzhou, Gansu, China; 3 Outpatient Service, Gansu Provincial Hospital, Lanzhou, Gansu, China
*Correspondence: Junjie Ren, Email not available
Abstract
Smoking among persons living with HIV infection (PLWH) is estimated to be 2-3 times greater than that in the general population. Data suggest that cigarette smoking is more common among PLWH because of several factors, including lower socioeconomic status, previous, or concurrent illicit drug and alcohol use, younger age, lower education level, and concomitant depressive symptoms. Cigarette smoking among PLWH has been associated with a higher risk of certain cancers and infections as well as lowered response to antiretroviral therapy. Randomized controlled trials on behavioral interventions for tobacco use among smokers with HIV were searched in the PubMed, Cochrane Library, EMBASE, and Web of Science databases. The retrieval period was from the inception of databases to November 2023. Network meta-analysis (NMA) was performed using the Stata 18.0 software with 19 studies (3190 subjects), of which 15 reported 7-day point prevalence abstinence and seven of which reported continuous abstinence. The NMA results showed that compared with general advice plus self-help brochure, text messaging (relative risk [RR] = 4.60, 95% confidence interval [CI], 1.12-18.81) and cell phone counseling (RR = 3.29, 95% CI, 1.71-6.32) were the most effective for 7-day point prevalence abstinence among smokers with HIV infection. Moreover, the metaanalysis showed that compared with smoking counseling and self-help brochures, continuous abstinence was statistically significantly enhanced after behavioral interventions (RR = 2.52, 95% CI, 1.51-4.20). The study revealed very low-to-high-quality evidence that text messaging, telephone counseling, and smoking cessation websites were effective for smokers with HIV infection.
