Title:Prevalence of HIV-Seropositivity and Associated Impact on Mortality among Injured Patients from Low-and Middle-Income Countries: A Systematic Review and Meta-Analysis
VOLUME: 15 ISSUE: 5
Author(s):Adam R. Aluisio*, Soham Rege, Barclay T. Stewart, John Kinuthia, Adam C. Levine, Michael J. Mello and Carey Farquhar
Affiliation:Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, Department of Surgery, University of Washington, Seattle, Department of Research & Programs, Kenyatta National Hospital, Nairobi, Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, RI, Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, RI, Epidemiology and hMedicine, University of Washington, Seattle
Keywords:HIV, Injury, low and-middle-income countries (LMIC), screening, mortality, sub-Saharan Africa.
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.
