Global Prevalence of Tobacco Smoking in People Living With Hepatitis C ─ Implications for Maximizing the Health Benefits From Antiviral Therapy: A Meta-Analysis

Long-term antiviral treatment outcomes of hepatitis C infection may be affected by tobacco smoking. This study determined the prevalence of tobacco smoking in people living with hepatitis C virus (PLHCV) in low-and middle-income (LMICs) and high-income countries (HICs). We searched PubMed, EMBASE, PsycINFO, and ProQuest for studies published between January 1, 2008, and August 31, 2018. The quality of included studies was assessed using the Newcastle-Ottawa Scale. We performed meta-analysis using the Freeman-Tukey double arcsine transformation. We used Eggers test to check for publication bias and performed meta-regression to identify individual-level sources of heterogeneity. The prevalence of tobacco smoking in PLHCV was 53.0%; it was 58% in LMICs and 52.0% in HICs. In subgroup analysis, the prevalence of tobacco smoking in PLHCV from clinic-based studies was 51% (95%CI 45%-57%) and it was 61% (95%CI 48%-73%) in community-based studies. In the multivariable meta-regression, study setting (coefficient=0.19, p<0.025) contributed significantly to the presence of heterogeneity between studies. Given the disproportionately high prevalence of tobacco smoking in PLHCV, addressing tobacco smoking in HCV treatment settings is recommended to maximise health benefits from antiviral therapy. That is particularly important in LMICs, where the burden of both tobacco smoking and HCV infection is growing.