Prevalence of HIV-Seropositivity and Associated Impact on Mortality among Injured Patients from Low-and Middle-Income Countries: A Systematic Review and Meta-Analysis

Adam R Aluisio; Soham Rege; Barclay T Stewart; John Kinuthia; Adam C Levine; Michael J Mello; Carey Farquhar

doi:10.2174/1570162X15666170920112743

Prevalence of HIV-Seropositivity and Associated Impact on Mortality among Injured Patients from Low-and Middle-Income Countries: A Systematic Review and Meta-Analysis

Curr HIV Res. 2017 Nov 23;15(5):307-317. doi: 10.2174/1570162X15666170920112743.

Authors

Adam R Aluisio¹, Soham Rege², Barclay T Stewart^{3

4}, John Kinuthia⁵, Adam C Levine¹, Michael J Mello¹, Carey Farquhar^{6

7

8}

Affiliations

¹ Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, RI, USA.
² Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, United States.
³ Department of Surgery, University of Washington, Seattle, USA.
⁴ Department of Interdisciplinary Health Sciences, Stellenbosch University, Cape Town, South Africa.
⁵ Department of Research & Programs, Kenyatta National Hospital, Nairobi, Kenya.
⁶ Department of Global Health, University of Washington, Seattle, USA.
⁷ Department of Epidemiology, University of Washington, Seattle, USA.
⁸ Department of hMedicine, University of Washington, Seattle, USA.

PMID: 28933280
DOI: 10.2174/1570162X15666170920112743

Abstract

Background: Although HIV and injury contribute substantially to disease burdens in lowand middle-income countries (LMIC), their intersection is poorly characterized.

Objective: This systematic review assessed the prevalence and associated mortality impact of HIVseropositivity among injured patients in LMIC.

Methods: A systematic search of PubMed, EMBASE, Global Health, CINAHL, POPLINE and Cochrane databases through August 2016 was performed. Prospective and cross-sectional reports of injured patients from LMIC that evaluated HIV-serostatus were included. Two reviewers identified eligible records (kappa=0.83); quality was assessed using GRADE criteria. HIV-seroprevalence and mortality risks were summarized and pooled estimates were calculated using random-effects models with heterogeneity assessed.

Results: Of 472 retrieved records, sixteen met inclusion. All reports were of low or very low quality and derived from sub-Saharan Africa. HIV-serostatus was available for 3,994 patients. Individual report and pooled HIV-seroprevalence estimates were uniformly greater than temporally matched national statistics (range: 4.5-35.0%). Pooled reports from South Africa were three-fold greater than matched national prevalence (32.0%, 95% CI, 28.0-37.0%). Mortality data were available for 1,398 patients. Heterogeneity precluded pooled mortality analysis. Among individual reports, 66.7% demonstrated significantly increased relative risks (RR) of death; none found reduced risk of death among HIV-seropositive patients. Increased mortality risk among HIV-seropositive patients ranged from 1.86 (95% CI, 1.11-3.09) in Malawi to 10.7 (95% CI, 1.32-86.1) in South Africa.

Conclusion: The available data indicate that HIV-seropositivity among the injured is high relative to national rates and may increase mortality, suggesting that integrated HIV-injury programming could be beneficial. Given the data limitations, further study of the HIV-injury intersection is crucially needed.

Keywords: HIV; Injury; low and-middle-income countries (LMIC); mortality; screening; sub-Saharan Africa..

Publication types

Meta-Analysis
Review
Systematic Review

MeSH terms

Africa South of the Sahara / epidemiology
Developing Countries
HIV Seropositivity / epidemiology*
HIV Seropositivity / mortality*
Humans
Risk Assessment
Seroepidemiologic Studies
Survival Analysis
Wounds and Injuries / complications*
Wounds and Injuries / diagnosis