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Clin Infect Dis. 2019 Aug 11. pii: ciz539. doi: 10.1093/cid/ciz539. [Epub ahead of print]

Human Immunodeficiency Virus Infection and Diverse Physical Health Outcomes: An Umbrella Review of Meta-analyses of Observational Studies.

Author information

1
Department of Social and Preventive Medicine, Center for Public Health, Medical University of Vienna, Austria.
2
Neuroscience Institute, Aging Branch, National Research Council, Padua, Italy.
3
Institute of Outcomes Research, Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Austria.
4
Department of Behavioural Science and Health, University College London, United Kingdom.
5
Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Fundació Sant Joan de Déu, Centro de Investigación Biomédica en Red de Salud Mental, Spain.
6
2nd Department of Respiratory and Critical Care, Otto Wagner Hospital, Vienna, Austria.
7
Physiotherapy Department, South London and Maudsley National Health Service Foundation Trust, London, United Kingdom.
8
National Institute of Complementary Medicine Health Research Institute, Western Sydney University, Westmead, Australia.
9
Department of Geriatric Medicine, Bezmialem Vakif University, Faculty of Medicine, Istanbul, Turkey.
10
Clinic of Infectious Diseases University of Bari, Italy.
11
Primary Care Department, Azienda Usl Toscana Sud Est, Grosseto, Italy.
12
School of Psychology and Sport Science, Anglia Ruskin University, Cambridge, United Kingdom.
13
Pennine Acute Hospitals, NHS Trust, United Kingdom.
14
Department of Cancer Epidemiology and Prevention Research, Alberta Health Services, Holy Cross Centre, Canada.
15
Preventive Oncology & Community Health Sciences, Cumming School of Medicine, University of Calgary, Canada.
16
The Cambridge Centre for Sport and Exercise Sciences, Anglia Ruskin University, United Kingdom.

Abstract

BACKGROUND:

Our aim was to assess both the credibility and strength of evidence arising from systematic reviews with meta-analyses of observational studies and physical health outcomes associated with human immunodeficiency virus (HIV) but not acquired immunodeficiency syndrome.

METHODS:

We performed an umbrella review of observational studies. Evidence was graded as convincing, highly suggestive, suggestive, weak, or nonsignificant.

RESULTS:

From 3413 studies returned, 20 were included, covering 55 health outcomes. Median number of participants was 18 743 (range 403-225 000 000). Overall, 45 (81.8%) of the 55 unique outcomes reported nominally significant summary results (P < .05). Only 5 outcomes (9.0%; higher likelihood of presence of breathlessness, higher chronic obstructive pulmonary disease [COPD] prevalence, maternal sepsis, higher risk of anemia, and higher risk of all fractures among people living with HIV [PLWHIV]) showed suggestive evidence, with P values < 10-3; only 3 (5.5%; higher prevalence of cough in cross-sectional studies, higher incidence of pregnancy-related mortality, and higher incidence of ischemic heart disease among PLWHIV in cohort studies) outcomes showed stronger evidence using a stringent P value (<10-6). None of the unique outcomes presented convincing evidence (Class I), yet 3 outcomes presented highly suggestive evidence, 5 outcomes presented suggestive evidence, and 37 outcomes presented weak evidence.

CONCLUSIONS:

Results show highly suggestive and suggestive evidence for HIV and the presence of a cough, COPD, ischemic heart disease, pregnancy-related mortality, maternal sepsis, and bone fractures. Public health policies should reflect and accommodate these changes, especially in light of the increases in the life expectancy and the incidence of comorbidities in this population.

KEYWORDS:

HIV; comorbid; health outcomes; human immunodeficiency virus; umbrella review

PMID:
31401650
DOI:
10.1093/cid/ciz539

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