Background: Smoking is important modifiable risk factors for cardiovascular disease (CVD). Although the health benefits of smoking cessation are well-documented, fewer people attended the smoking cessation program. The trajectory of CVD risk scores would be useful for risk management, especially those infected with HIV (human immunodeficiency virus), as their medication may increase such risks.
Objectives: The study aims to estimate the prevalence of smoking among HIV-positive person, to identify the stage of change and its willingness towards referred to smoking cessation program, and to estimate the change of CVD risk profile among HIV-positive individuals.
Methods: This study was conducted in two part. In part I, a systematic review with meta-analysis was conducted to estimate the global prevalence of smoking in HIV-positive individuals. We searched major English databases, PubMed, Ovid, and EBSCOhost, to identify English-language articles published between 2000 and 28th February 2017. A random-effects model was selected to summarize the prevalence of smoking. In Part II, a prospective cohort study was conducted at HIV clinics of an AIDS designated hospital in southern Taiwan. We enrolled people diagnosed with HIV, age over 18 years old and not under CVD medication. They were followed every six months up to 12 months to determine the change of CVD risks based on D:A: D reduce model. Mixed-effect models were constructed to explore determinants.
Results: Part I study, a total of 33 articles from 2,763 studies were included, and 31 articles were pooled in a meta-analysis. The estimated prevalence of current smoking is 46.5% (95%CI: 40.9-52.1). The highest current smoking prevalence was found in European countries (46.4%), males (75.9%), and men who have sex with men (MSM) (52.1%). Part II clinical study, of 423 HIV-positive persons, 33.9% were a current smoker with the majority in pre-contemplation stage and 33% willing to smoking cessation. Age, education, CD4 counts, viral load, diabetic, hepatitis B, exposure smoking cessation information were associated with stage of change. In the CVD risk estimation, among 423, only 411 participants completed measurement; aged ranged from 19 to 77 years; 95.9% were male. At baseline, the majority of participants 47% were at low risk of CVD. About 18.96% of HIV-positive persons declined their CVD risk. Diagnosed with hepatitis C co-infection, receiving ART contained Lopinavir and Abacavir, longer duration of Lopinavir use were significant predictors of higher D: A: D risk score. In addition, higher education, used of the NNRTI-based regiment, used of lipid and BP-lowering agent were significant predictors of lower D: A: D risk score.
Conclusion: Our findings suggested a higher prevalence of smoking and low rate of willingness to quit smoking. There was a reduction of CVD risk in HIV-positive persons after 12 months-follow up. Development and consolidation of guidelines for integrated smoking cessation, CVD and HIV care are essential to control the burden of CVD in HIV-positive populations.

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