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The aim was to assess whether smoking is a risk factor for pneumonia in people with HIV and whether smoking cessation ameliorates excess risk.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We performed MEDLINE and Embase database searches and included cohort or case-control studies conducted in adult patients infected with HIV extracting a hazard ratio (HR) or odds ratio (OR) that compared the incidence of bacterial pneumonia or pneumonia caused by<jats:italic>Pneumocystis jiroveci<\/jats:italic>(PCP) between two smoking categories. Studies were appraised for quality and combined using inverse variance meta-analysis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Fourteen cohort and case-control studies were included. Assessment of outcome was good, but assessment of exposure status was poor. Current smokers were at higher risk of bacterial pneumonia than former smokers: HR 1.37 (95% confidence interval (CI): 1.06, 1.78). There was no evidence that former smokers were at higher risk than never smokers: HR 1.24 (95%CI: 0.96, 1.60). Current smokers were at higher risk of bacterial pneumonia than current non-smokers: HR of 1.73 (95%CI: 1.44, 2.06). There was no evidence that smoking increased the incidence of PCP. The HR for current versus non-smokers was 0.94 (95%CI: 0.79, 1.12), but from case-control studies the OR was 1.76 (95%CI: 1.25, 2.48) with heterogeneity. Confined to higher quality studies, the OR was 0.97 (95%CI: 0.81, 1.16). Residual confounding is possible, but available data suggest this is not an adequate explanation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Smoking is a risk factor for bacterial pneumonia but not PCP and smoking cessation reduces this risk.<\/jats:p><jats:p>See related article:<jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"http:\/\/www.biomedcentral.com\/1741-7015\/11\/16\" ext-link-type=\"uri\">http:\/\/www.biomedcentral.com\/1741-7015\/11\/16<\/jats:ext-link><\/jats:p><\/jats:sec>","DOI":"10.1186\/1741-7015-11-15","type":"journal-article","created":{"date-parts":[[2013,1,22]],"date-time":"2013-01-22T09:15:36Z","timestamp":1358846136000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":38,"title":["Systematic review and meta-analysis: influence of smoking cessation on incidence of pneumonia in HIV"],"prefix":"10.1186","volume":"11","author":[{"given":"Preeti","family":"De","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amanda","family":"Farley","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicola","family":"Lindson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Aveyard","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2013,1,22]]},"reference":[{"key":"690_CR1","doi-asserted-by":"publisher","first-page":"194","DOI":"10.1097\/01.qai.0000179459.31562.16","volume":"41","author":"NF Crum","year":"2006","unstructured":"Crum NF, Riffenburgh RH, Wegner S, Agan BK, Tasker SA, Spooner KM, Armstrong AW, Fraser S, Wallace MR, on Behalf of the Triservice AIDS Clinical Consortium: Comparisons of causes of death and mortality rates among HIV-Infected persons: analysis of the pre-, early, and late HAART (highly active antiretroviral therapy) eras. 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