背景:艾滋病毒携带者(PLWH)的烟草使用率是普通人群的四倍。不幸的是,烟草使用增加了进展为艾滋病和死亡的风险。个人和团体层面的干预措施,和有效帮助PLWH停止使用烟草的系统改变干预措施可以显着改善该人群的健康和生活质量。然而,缺乏指导政策和实践的明确证据,这阻碍了将戒烟干预措施纳入常规艾滋病毒护理。这是2016年发布的评论的更新。我们包括11项新研究。
目标:为了评估收益,艾滋病毒感染者戒烟干预措施的危害和耐受性。为了比较好处,针对艾滋病毒感染者的需求量身定制的戒烟干预措施的危害和耐受性,以及非定制的戒烟干预措施。
方法:我们搜索了Cochrane烟草成瘾小组的专业登记册,中部,MEDLINE,Embase,和PsycINFO在2022年12月。
方法:我们纳入了个人/团体水平的行为或药物干预的随机对照试验(RCT),或者两者兼而有之,戒烟,直接交付给18岁及以上的PLWH,使用烟草的人。我们还包括RCT,准RCT,其他非随机对照研究(如研究前后对照),并中断了PLWH戒烟系统变化干预措施的时间序列研究。对于系统变更干预措施,参与者可能是PLWH接受护理,或在医疗机构工作并为PLWH提供护理的工作人员;但排除了由研究人员进行干预的研究。对于个人/团体层面的干预,和系统变革干预措施,任何比较者都有资格。
方法:我们遵循标准的Cochrane方法,并使用等级来评估证据的确定性。受益的主要衡量标准是戒烟至少六个月。危害的主要措施是不良事件(AE)和严重不良事件(SAE)。我们还测量了戒烟尝试或戒烟事件,接受戒烟干预,生活质量,HIV病毒载量,CD4计数,和机会性感染的发生率。
结果:我们确定了17项研究(16项随机对照研究和一项非随机研究),共有9959名参与者;11项研究是本次更新的新研究。9项研究促成了荟萃分析(2741名参与者)。15项研究评估了个人/团体层面的干预措施,和两项评估的系统变更干预措施。12项研究来自美国,两个来自瑞士,还有对法国的单一研究,俄罗斯和南非。所有研究都集中在戒烟上。所有研究都来自独立的国家或机构级资金。三项研究从一家制药公司免费获得研究药物。在16个随机对照试验中,三个人总体上有较低的偏见风险,五个处于高风险,八个人处于不清楚的危险之中。行为支持或系统改变干预措施与没有或不那么密集的行为支持低确定性证据(7项研究,2314名参与者)与简短建议或无干预相比,在随机接受行为支持的PLWH中,戒烟率没有明显的益处:风险比(RR)1.11,95%置信区间(CI)0.87至1.42,没有异质性的证据。对照组6个月或更长时间的禁欲为10%(n=108/1121),干预组为11%(n=127/1193)。没有证据表明戒烟对系统改变干预措施有影响:在患者仍在医院时拨打戒烟电话并将电话转接给患者(“温暖移交”)与传真转诊(RR3.18,95%CI0.76至13.99;1项研究,25名参与者;非常低的确定性证据)。该比较中没有一项研究评估了SAE。药物干预与安慰剂,没有干预,或其他药物治疗中度确定性证据(2项研究,427名参与者)建议与安慰剂相比,伐尼克兰可能有助于更多的PLWH戒烟(RR1.95,95%CI1.05至3.62),没有异质性的证据。安慰剂对照组中六个月或更长时间的禁欲为7%(n=14/215),伐尼克兰组为13%(n=27/212)。没有证据表明行为支持加尼古丁替代疗法(NRT)与简短建议的个体研究的干预效果(RR8.00,95%CI0.51至126.67;15名参与者;非常低的确定性证据),行为支持加NRT与单独的行为支持(RR1.47,95%CI0.92至2.36;560名参与者;低确定性证据),伐尼克兰与NRT(RR0.93,95%CI0.48至1.83;200名参与者;非常低的确定性证据),和金雀花碱与NRT(RR1.18,95%CI0.66至2.11;200名参与者;非常低的确定性证据)。低确定性证据(2项研究,427名参与者)在经历SAE的参与者比例(8%(n=17/212)与7%(n=15/215)中没有检测到伐尼克兰和安慰剂之间的差异,分别为RR1.14,95%CI0.58至2.22),没有异质性的证据。一项研究的低确定性证据表明,行为支持加NRT和行为支持之间的SAE率相似(1.8%(n=5/279)与1.4%(n=4/281),分别为RR1.26,95%CI0.34至4.64)。没有研究评估了以下方面的SAE:行为支持加NRT与简短建议;伐尼克兰与NRT和野西汀与NRT。
结论:没有明确的证据支持或反驳在简短的建议中使用行为支持,一种行为支持超过另一种,行为支持加NRT,而不是行为支持或简短的建议,Varenicline超过NRT,在PLWH中,或因NRT而戒烟六个月或更长时间。也没有明确的证据支持或反驳使用系统变更干预措施,例如通过传真转介进行热移交,在使用烟草的PLWH中增加戒烟或接受戒烟干预措施。然而,必须在纳入的研究数量较少的情况下考虑结果.与对照组相比,伐尼克兰可能有助于PLWH戒烟六个月或更长时间。我们没有发现伐尼克兰和安慰剂之间SAE发生率差异的证据,尽管证据的确定性很低。
The prevalence of tobacco use among people living with HIV (PLWH) is up to four times higher than in the general population. Unfortunately, tobacco use increases the risk of progression to AIDS and death. Individual- and group-level interventions, and system-change interventions that are effective in helping PLWH stop using tobacco can markedly improve the health and quality of life of this population. However, clear evidence to guide policy and practice is lacking, which hinders the integration of tobacco use cessation interventions into routine HIV care. This is an update of a review that was published in 2016. We include 11 new studies.
To assess the benefits, harms and tolerability of interventions for tobacco use cessation among people living with HIV. To compare the benefits, harms and tolerability of interventions for tobacco use cessation that are tailored to the needs of people living with HIV with that of non-tailored cessation interventions.
We searched the Cochrane Tobacco Addiction Group\'s Specialised Register, CENTRAL, MEDLINE, Embase, and PsycINFO in December 2022.
We included randomised controlled trials (RCTs) of individual-/group-level behavioural or pharmacological interventions, or both, for tobacco use cessation, delivered directly to PLWH aged 18 years and over, who use tobacco. We also included RCTs, quasi-RCTs, other non-randomised controlled studies (e.g. controlled before and after studies), and interrupted time series studies of system-change interventions for tobacco use cessation among PLWH. For system-change interventions, participants could be PLWH receiving care, or staff working in healthcare settings and providing care to PLWH; but studies where intervention delivery was by research personnel were excluded. For both individual-/group-level interventions, and system-change interventions, any comparator was eligible.
We followed standard Cochrane methods, and used GRADE to assess certainty of the evidence. The primary measure of benefit was tobacco use cessation at a minimum of six months. Primary measures for harm were adverse events (AEs) and serious adverse events (SAEs). We also measured quit attempts or quit episodes, the receipt of a tobacco use cessation intervention, quality of life, HIV viral load, CD4 count, and the incidence of opportunistic infections.
We identified 17 studies (16 RCTs and one non-randomised study) with a total of 9959 participants; 11 studies are new to this update. Nine studies contributed to meta-analyses (2741 participants). Fifteen studies evaluated individual-/group-level interventions, and two evaluated system-change interventions. Twelve studies were from the USA, two from Switzerland, and there were single studies for France, Russia and South Africa. All studies focused on cigarette smoking cessation. All studies received funding from independent national- or institutional-level funding. Three studies received study medication free of charge from a pharmaceutical company. Of the 16 RCTs, three were at low risk of bias overall, five were at high risk, and eight were at unclear risk. Behavioural support or system-change interventions versus no or less intensive behavioural support Low-certainty evidence (7 studies, 2314 participants) did not demonstrate a clear benefit for tobacco use cessation rates in PLWH randomised to receive behavioural support compared with brief advice or no intervention: risk ratio (RR) 1.11, 95% confidence interval (CI) 0.87 to 1.42, with no evidence of heterogeneity. Abstinence at six months or more was 10% (n = 108/1121) in the control group and 11% (n = 127/1193) in the intervention group. There was no evidence of an effect on tobacco use cessation on system-change interventions: calling the quitline and transferring the call to the patient whilst they are still in hospital (\'warm handoff\') versus fax referral (RR 3.18, 95% CI 0.76 to 13.99; 1 study, 25 participants; very low-certainty evidence). None of the studies in this comparison assessed SAE. Pharmacological interventions versus placebo, no intervention, or another pharmacotherapy Moderate-certainty evidence (2 studies, 427 participants) suggested that varenicline may help more PLWH to quit smoking than placebo (RR 1.95, 95% CI 1.05 to 3.62) with no evidence of heterogeneity. Abstinence at six months or more was 7% (n = 14/215) in the placebo control group and 13% (n = 27/212) in the varenicline group. There was no evidence of intervention effects from individual studies on behavioural support plus nicotine replacement therapy (NRT) versus brief advice (RR 8.00, 95% CI 0.51 to 126.67; 15 participants; very low-certainty evidence), behavioural support plus NRT versus behavioural support alone (RR 1.47, 95% CI 0.92 to 2.36; 560 participants; low-certainty evidence), varenicline versus NRT (RR 0.93, 95% CI 0.48 to 1.83; 200 participants; very low-certainty evidence), and cytisine versus NRT (RR 1.18, 95% CI 0.66 to 2.11; 200 participants; very low-certainty evidence). Low-certainty evidence (2 studies, 427 participants) did not detect a difference between varenicline and placebo in the proportion of participants experiencing SAEs (8% (n = 17/212) versus 7% (n = 15/215), respectively; RR 1.14, 95% CI 0.58 to 2.22) with no evidence of heterogeneity. Low-certainty evidence from one study indicated similar SAE rates between behavioural support plus NRT and behavioural support only (1.8% (n = 5/279) versus 1.4% (n = 4/281), respectively; RR 1.26, 95% CI 0.34 to 4.64). No studies assessed SAEs for the following: behavioural support plus NRT versus brief advice; varenicline versus NRT and cytisine versus NRT.
There is no clear evidence to support or refute the use of behavioural support over brief advice, one type of behavioural support over another, behavioural support plus NRT over behavioural support alone or brief advice, varenicline over NRT, or cytisine over NRT for tobacco use cessation for six months or more among PLWH. Nor is there clear evidence to support or refute the use of system-change interventions such as warm handoff over fax referral, to increase tobacco use cessation or receipt of cessation interventions among PLWH who use tobacco. However, the results must be considered in the context of the small number of studies included. Varenicline likely helps PLWH to quit smoking for six months or more compared to control. We did not find evidence of difference in SAE rates between varenicline and placebo, although the certainty of the evidence is low.