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

[ Vol. 15 , Issue. 5 ]


Adam R. Aluisio*, Soham Rege, Barclay T. Stewart, John Kinuthia, Adam C. Levine, Michael J. Mello and Carey Farquhar   Pages 307 - 317 ( 11 )


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.


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


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

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