Use of Tobacco and Alternative Nicotine Products Among People with HIV: A Cross-Sectional Multicenter Survey

People with HIV (PWH) have a higher prevalence of smoking compared to the general population, which contributes to an increased risk of non-AIDS-related comorbidities. 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.