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