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Heated tobacco products (HTPs) and electronic cigarettes (e-cigarettes) have added complexity to tobacco use behaviors. This study aimed to investigate smoking habits, including HTPs and e-cigarettes use and to describe patterns of tobacco use. We conducted a cross-sectional survey among PWH attending five Italian University Hospitals. An anonymous questionnaire collected information on smoking status, history, use of HTPs and e-cigarettes, motivations for product use, and engagement with smoking cessation services and lung health screenings. A total of 1,081 PWH were included: 41.9% were current smokers (CS), 31.5% former smokers (FS), and 26.6% never smokers. CS reported a median consumption of 15 cigarettes per day and a smoking duration of 30 years. HTP use was reported by 10.6% of participants, most commonly among FS and CS, while e-cigarette use was reported by 15.9%, with the highest prevalence among younger individuals. Dual use of cigarettes and e-cigarettes was found in 21.0% of CS. The main reasons for e-cigarette use were smoking reduction (75%) and perceived lower harm (53.5%). Only 5% of participants accessed smoking cessation services, and 60.5% of CS had attempted to quit, but physician recommendations for cessation support were infrequent (21.0%). Lung health screening was underutilized, with only 17.0% undergoing a CT scan and 12.7% a pulmonology consultation. These findings underscore the need for targeted strategies to address tobacco use and improve preventive care in PWH.<\/jats:p>","DOI":"10.1007\/s10461-025-04958-7","type":"journal-article","created":{"date-parts":[[2025,11,13]],"date-time":"2025-11-13T05:11:12Z","timestamp":1763010672000},"page":"1088-1096","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Use of Tobacco and Alternative Nicotine Products Among People with HIV: A Cross-Sectional Multicenter Survey"],"prefix":"10.1007","volume":"30","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8265-5400","authenticated-orcid":false,"given":"Andrea","family":"De Vito","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Giacomelli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"Mazzitelli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gianmaria","family":"Baldin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Massimiliano","family":"Fabbiani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Agnese","family":"Colpani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miriam","family":"Galimberti","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Carbone","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aurora","family":"Civati","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annamaria","family":"Cattelan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simona","family":"Di Giambenedetto","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giordano","family":"Madeddu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,11,13]]},"reference":[{"key":"4958_CR1","unstructured":"WHO (2023). 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