Aluisio Adam R, Rege Soham, Stewart Barclay T, Kinuthia John, Levine Adam C, Mello Michael J, Farquhar Carey
Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, RI, USA.
Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, United States.
Curr HIV Res. 2017 Nov 23;15(5):307-317. doi: 10.2174/1570162X15666170920112743.
Although HIV and injury contribute substantially to disease burdens in lowand middle-income countries (LMIC), their intersection is poorly characterized.
This systematic review assessed the prevalence and associated mortality impact of HIVseropositivity among injured patients in LMIC.
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.
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.
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.
尽管艾滋病毒和伤害在低收入和中等收入国家（LMIC）的疾病负担中占很大比例，但它们之间的交叉情况却鲜有描述。
本系统评价评估了低收入和中等收入国家受伤患者中艾滋病毒血清阳性的患病率及其对死亡率的相关影响。
对截至2016年8月的PubMed、EMBASE、全球卫生、护理学与健康领域数据库、人口在线数据库和考科蓝数据库进行了系统检索。纳入了来自低收入和中等收入国家的受伤患者的前瞻性和横断面报告，这些报告评估了艾滋病毒血清状态。两名评审员确定了符合条件的记录（kappa=0.83）；使用GRADE标准评估质量。总结了艾滋病毒血清阳性率和死亡风险，并使用随机效应模型计算汇总估计值，同时评估异质性。
在检索到的472条记录中，16条符合纳入标准。所有报告的质量都很低或非常低，且均来自撒哈拉以南非洲。3994名患者的艾滋病毒血清状态信息可用。各份报告及汇总的艾滋病毒血清阳性率估计值均普遍高于同期匹配的国家统计数据（范围：4.5%-35.0%）。来自南非的汇总报告比匹配的国家患病率高出三倍（32.0%，95%置信区间，28.0%-37.0%）。1398名患者有死亡数据。异质性使汇总死亡率分析无法进行。在各份报告中，66.7%显示艾滋病毒血清阳性患者的死亡相对风险（RR）显著增加；没有一份报告发现艾滋病毒血清阳性患者的死亡风险降低。艾滋病毒血清阳性患者的死亡风险增加范围从马拉维的1.86（95%置信区间，1.11-3.09）到南非的10.7（95%置信区间，1.32-86.1）。
现有数据表明，受伤患者中的艾滋病毒血清阳性率相对于国家发病率较高，且可能增加死亡率，这表明整合艾滋病毒与伤害防治规划可能有益。鉴于数据有限，迫切需要进一步研究艾滋病毒与伤害的交叉情况。
