Department of Health Sciences, Faculty of Science, University of York, Heslington, York, UK.
Department of Health Sciences, Faculty of Science, University of York, Heslington, York, UK.
Lancet Glob Health. 2017 Jun;5(6):e578-e592. doi: 10.1016/S2214-109X(17)30170-5.
Tobacco use among people living with HIV results in excess morbidity and mortality. However, very little is known about the extent of tobacco use among people living with HIV in low-income and middle-income countries (LMICs). We assessed the prevalence of tobacco use among people living with HIV in LMICs.
We used Demographic and Health Survey data collected between 2003 and 2014 from 28 LMICs where both tobacco use and HIV test data were made publicly available. We estimated the country-specific, regional, and overall prevalence of current tobacco use (smoked, smokeless, and any tobacco use) among 6729 HIV-positive men from 27 LMICs (aged 15-59 years) and 11 495 HIV-positive women from 28 LMICs (aged 15-49 years), and compared them with those in 193 763 HIV-negative men and 222 808 HIV-negative women, respectively. We estimated prevalence separately for males and females as a proportion, and the analysis accounted for sampling weights, clustering, and stratification in the sampling design. We computed pooled regional and overall prevalence estimates through meta-analysis with the application of a random-effects model. We computed country, regional, and overall relative prevalence ratios for tobacco smoking, smokeless tobacco use, and any tobacco use separately for males and females to study differences in prevalence rates between HIV-positive and HIV-negative individuals.
The overall prevalence among HIV-positive men was 24·4% (95% CI 21·1-27·8) for tobacco smoking, 3·4% (1·8-5·6) for smokeless tobacco use, and 27·1% (22·8-31·7) for any tobacco use. We found a higher prevalence in HIV-positive men of any tobacco use (risk ratio [RR] 1·41 [95% CI 1·26-1·57]) and tobacco smoking (1·46 [1·30-1·65]) than in HIV-negative men (both p<0·0001). The difference in smokeless tobacco use prevalence between HIV-positive and HIV-negative men was not significant (1·26 [1·00-1·58]; p=0·050). The overall prevalence among HIV-positive women was 1·3% (95% CI 0·8-1·9) for tobacco smoking, 2·1% (1·1-3·4) for smokeless tobacco use, and 3·6% (95% CI 2·3-5·2) for any tobacco use. We found a higher prevalence in HIV-positive women of any tobacco use (RR 1·36 [95% CI 1·10-1·69]; p=0·0050), tobacco smoking (1·90 [1·38-2·62]; p<0·0001), and smokeless tobacco use (1·32 [1·03-1·69]; p=0·030) than in HIV-negative women.
The high prevalence of tobacco use in people living with HIV in LMICs mandates targeted policy, practice, and research action to promote tobacco cessation and to improve the health outcomes in this population.
South African Medical Research Council and the UK Medical Research Council.
艾滋病毒感染者吸烟会导致发病率和死亡率过高。然而，人们对中低收入国家（LMICs）艾滋病毒感染者吸烟的程度知之甚少。我们评估了 LMICs 中艾滋病毒感染者吸烟的流行程度。
我们使用了 2003 年至 2014 年期间在 28 个 LMIC 中收集的人口与健康调查数据，这些国家都公开提供了烟草使用和艾滋病毒检测数据。我们估计了 27 个 LMIC 中 6729 名 15-59 岁艾滋病毒阳性男性（分别为 15-49 岁的 11495 名艾滋病毒阳性女性）中当前吸烟（吸烟、无烟和任何烟草使用）的国家、区域和总体流行率，并将其与 193763 名 HIV 阴性男性和 222808 名 HIV 阴性女性进行了比较。我们分别按比例计算了男性和女性的流行率，并在分析中考虑了抽样权重、聚类和抽样设计中的分层。我们通过应用随机效应模型的荟萃分析计算了区域和总体汇总流行率估计值。我们计算了针对男性和女性的单独的烟草使用、无烟烟草使用和任何烟草使用的国家、区域和总体相对流行率比，以研究 HIV 阳性和 HIV 阴性个体之间的流行率差异。
艾滋病毒阳性男性的总体吸烟流行率为 24.4%（95%CI 21.1-27.8），无烟烟草使用流行率为 3.4%（1.8-5.6），任何烟草使用流行率为 27.1%（22.8-31.7）。我们发现，艾滋病毒阳性男性的任何烟草使用（风险比 [RR] 1.41 [95%CI 1.26-1.57]）和吸烟（1.46 [1.30-1.65]）的流行率均高于 HIV 阴性男性（均 p<0.0001）。艾滋病毒阳性男性与 HIV 阴性男性之间的无烟烟草使用流行率差异无统计学意义（1.26 [1.00-1.58]；p=0.050）。艾滋病毒阳性女性的总体吸烟流行率为 1.3%（95%CI 0.8-1.9），无烟烟草使用流行率为 2.1%（1.1-3.4），任何烟草使用流行率为 3.6%（95%CI 2.3-5.2）。我们发现，艾滋病毒阳性女性的任何烟草使用（RR 1.36 [95%CI 1.10-1.69]；p=0.0050）、吸烟（1.90 [1.38-2.62]；p<0.0001）和无烟烟草使用（1.32 [1.03-1.69]；p=0.030）的流行率均高于 HIV 阴性女性。
中低收入国家艾滋病毒感染者吸烟的高流行率需要有针对性的政策、实践和研究行动，以促进戒烟，并改善这一人群的健康结果。
南非医学研究理事会和英国医学研究理事会。
