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Behavioral Interventions for Tobacco Use in HIV-Infected Smokers: A Meta-Analysis

Keith, Asheena MD; Dong, Yuelei MD; Shuter, Jonathan MD; Himelhoch, Seth MD, MPH

JAIDS Journal of Acquired Immune Deficiency Syndromes: August 15th, 2016 - Volume 72 - Issue 5 - p 527–533
doi: 10.1097/QAI.0000000000001007
Clinical Science

Context: Smoking is responsible for increased morbidity and mortality in HIV-infected smokers.

Objective: To assess the efficacy of behavioral interventions for smoking cessation among HIV-infected smokers compared with the standard care.

Data sources: PubMed, Cochrane, CINHAL, PsychINFO, and Google Scholar were searched for randomized controlled trials published in English.

Study selection: Eligibility criteria were randomized controlled trials with targeted behavioral interventions compared with standard of care (or enhanced standard of care) aimed at promoting abstinence in HIV-infected smokers. A total of 17,384 articles were found and 17,371 were excluded; 13 full text articles were obtained and reviewed, and 8 met the eligibility criteria (Κ = 0.94).

Data extraction: The primary outcome was expired carbon monoxide–verified 7-day point prevalence abstinence rates. Adequate sequence generation and freedom from incomplete or selective outcome reporting was used to assess study quality.

Results: A total of 1822 subjects from 8 studies yielded a statistically significant effect of behavioral interventions in increasing abstinence in HIV-infected smokers with a moderate effect size (relative risk: 1.51; 95% confidence interval: 1.17 to 1.95). Those studies with interventions of 8 sessions or more had a large effect size for abstinence (relative risk: 2.88; 95% confidence interval: 1.89 to 4.61). When stratified by the number of sessions, there was no heterogeneity.

Conclusions: Targeted behavioral smoking cessation interventions are efficacious. Interventions consisting of 8 sessions or more had the greatest treatment efficacy.

*Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD; and

Department of Medicine, Division of Infectious Diseases, Montefiore Medical Center and the Albert Einstein College of Medicine, New York, NY.

Correspondence to: Seth Himelhoch, MD, MPH, Department of Psychiatry, University of Maryland School of Medicine, 737 West Lombard Street, Suite 560, Baltimore, MD 21201 (e-mail:

Presented in part at the Institute on Psychiatric Service, October 9, 2015 in New York, NY, and are scheduled to be presented at the American Psychiatric Association, May 16, 2016, Atlanta, GA.

The authors have no funding or conflicts of interest to disclose.

Received January 14, 2016

Accepted March 14, 2016

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