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

Introduction: Our aim was to assess both the credibility and strength of evidence arising from systematic reviews with meta-analyses of observational studies and non-ADIS defining physical health outcomes associated with HIV. Methods: We performed an umbrella review of observational studies. Evidence was graded as convincing, highly suggestive, suggestive, weak and non-significant. Results: From 3413 studies returned, 20 were included covering 55 health outcomes. Median number of participants was 18,743 (range: 403 to 225,000,000). Overall, 45 (81.8%) of the 55 unique outcomes reported nominally significant summary results (p<0.05). Only five outcomes (9.0%; higher likelihood of presence of breathlessness and COPD prevalence, maternal sepsis, higher risk of anemia and all fractures among PLWHIV) showed suggestive evidence with P values < 10-3 and three (5.5%; higher prevalence of cough in cross-sectional studies and higher incidence of pregnancy related mortality and ischemic heart disease among PLWHIV in cohort studies) outcomes showed a stronger evidence using a stringent P value (<10-6). None of the unique outcomes presented convincing evidence (class I), yet three outcomes presented highly suggestive evidence, five outcomes presented suggestive evidence and 37 outcomes presented a weak evidence. Discussion: Results show highly suggestive and suggestive evidence for HIV and presence of cough, prevalence of COPD, ischemic heart disease, pregnancy mortality and sepsis, and bone fractures. Public health policies should reflect and accommodate these changes, especially in light of the increases in life expectancy and incidence of comorbidities in this population.