Background
Methods
Review question
Population, exposure and outcome
Study design
Search strategy
Inclusion/exclusion criteria
Selection procedure
Quality assessment and data extraction
Results
Selection procedure
Quality of studies
Study | Design | Population, setting | Outcome: duration and follow-up | Study addresses an appropriate and clearly focused question | Participants being studied are selected from the same source populations | Indicate how many people participated | Main potential confounders identified and accounted for | How well was the study done to minimise the risk of bias or confounding? |
---|---|---|---|---|---|---|---|---|
1. Joore I.K. et al., (2015) [42] | Case-control study | 102 cases and 299 controls, Amsterdam, Netherlands | HIV infection: 2002–2012 | Yes | Yes | Yes | Cannot say | + |
2. Damery S. et al. (2013) [17] | Case-control study | 939 cases and 2576 control, UK | HIV/AIDS diagnosis: Jan 1989–Sept 2010 | Yes | Yes | Yes | Yes | ++ |
3. Szerlip M.A. et al. (2005) [39] | Case-control study (retrospective) | Older patients aged 55 years and over (53 cases and 106 controls), New Orleans, USA | Diagnosis of HIV infection: 6 months interval up to 12 months | Yes | Yes | Yes | Cannot say | + |
4. Ellerbrock T.V. (2004) [30] | Case-control study | 217 cases 395 controls, FL, USA | HIV diagnosis: 1998–2000 | Cannot say | Yes | Yes | Cannot say | + |
5. Burchell, A.N. (2010) | Case-control study | Gay and bisexual men 123 cases and 240 controls, Ontario, Canada | HIV infection: 1998–2006 | Yes | Yes | Yes | Yes | ++ |
6. Burchell, A. N. (2003) [41] | Case-control study | Adults aged 18 years and over 80 cases (seroconverts) and 106 controls, Ontario, Canada | Diagnosed HIV infection: June 1998–Dec 2001 | Yes | Yes | Yes | Yes | ++ |
7. Hodder, S.L. (2013) [36] | Cohort study (prospective) | N = 2099 (women aged 18–44 with 1 or more personal or partner risk factors), USA | HIV prevalence and incidence: 2009–2010 with 6-month follow-up to 12 months | Yes | Yes | Yes | Yes | + |
8. Moran. J. (2012) [34] | Cohort study | N = 1404 Ireland | HIV infection: 2008–2011 | Yes | Cannot say | Yes | No | + |
9. Desai M. (2012) [38] | Cohort study | N = 328 UK | HIV infection: Sept 2010–Dec 2011 | Yes | Cannot say | Yes | No | + |
10. Guy R.J. (2011) [35] | Cohort study | N = 7857 (MSM) Victoria, Australia | HIV positivity: Apr 2006–Jun 2009 | Yes | Yes | Yes | Cannot say | + |
11. Krauskopf K. (2011) [45] | Cohort study | N = 643 (HIV-infected and at-risk men aged 49 years and older), Bronx, NY, USA | HIV infection: 2001–2006 6-month follow-up | Yes | Yes | Yes | Yes | ++ |
12. Niyonsenga T (2013) [37] | Cohort study | N = 20,528 (all cases with HIV/AIDS diagnosis), FL, USA | AIDS/HIV incidence: 1998–2002 | Yes | Cannot say | Yes | Cannot say | + |
13. Ross, J. D. (1997) [31] | Cohort study | N = 8466 (population aged 16 and over), Lothian and Glasgow region of Scotland | HIV positive results: Jan 1989–Dec 1993 | Yes | Yes | |||
14. Gordon S. M. (1995) [32] | Cohort study | N = 32 (HIV-positive patients aged ≥ 60) Atlanta, GA, USA | HIV positivity: Jan 1985–July 1992 | Yes | No | Yes | No | + |
15. Marder K. (1995) [44] | Cohort study (prospective) | Intravenous drug users (99 HIV + ve patients 124 HIV − ve patients), New York City, USA | HIV infection: recruited 1988 and followed up for 3.5 years and 6-month follow-up | Yes | Yes | Yes | Yes | ++ |
16. Hafner J. W. (1997) [33] | Cohort study (retrospective) | N = 344 Albuquerque, NM, USA | HIV diagnosis: 19-month period July 1993–Jan 1995 | Yes | Yes | Cannot say | + | |
17. Landau R. (1997) [43] | Cohort study (retrospective) | N = 133 (A&E patients aware and unaware of HIV status), London, UK | HIV infection: 1991–1994 | Yes | Yes | Yes | No | + |
Study characteristics
Identified predictors of HIV infection
Demography and socio-economic
Studies | Ellerbrock 2004 [30] | Guy 2011 [35] | Hodder 2013 [36] | Ross 1997 [31] | Niyonsenga 2013 [37] | Gordon 1995 [32] | Desai 2012 [38] | Hafner 1997 [33] | Moran 2012 [34] | |
---|---|---|---|---|---|---|---|---|---|---|
OR | OR | OR | OR | CC** | % | % | % | |||
Demographic | ||||||||||
Age | Reference group | < 30 y | 18–26 years | 21–25 years | ||||||
26–30 | 1.7 (1.05–2.8) | |||||||||
27–33 | 5.83 (1.22–27.96) | |||||||||
30–39 | 1.91 (1.27-2.87) | |||||||||
31–35 | 0.3* | |||||||||
34+ | 11.54 (2.71–49.05) | |||||||||
36–40 | 1.6* | |||||||||
40+ | 1.81 (1.19-2.75) | |||||||||
Ethnicity | Black race (Reference = white) | 6.77 (4.17–11) | ||||||||
Aboriginal or Torres Strait Islander | 1.68* (0.41–6.94) | |||||||||
Country of birth | Born in USA | 1.76 (1.22–2.53) | ||||||||
Born in Australia | 1.42* (1.00–2.02) | |||||||||
Sexuality | Homosexual/bisexual | 1.79* (0.67–4.79) | 2.7 (1.5–4.8) | 37% | 57% | 61% | ||||
Heterosexual | 1.00 | 1.0 | 3% | 28% | ||||||
Socio-economic factor | ||||||||||
Housing problems | 17% | |||||||||
Poverty index in rural areas | − 0.25* | |||||||||
Poverty index in urban areas | 0.58 | |||||||||
Annual income < $10,000 | 13.2 (7.91–22) | |||||||||
Farmworker | 2.09 (1.47–2.96) | |||||||||
Unemployed | 5.08 (3.18–8.14) | 26% | ||||||||
Education beyond high school | 0.43* (0.15–1.24) | |||||||||
Not a high school graduate | 2.15 (1.48–3.1) |
Behavioural characteristics
Predictor | Ellerbrock 2004 [30] | Gordon 1995 [32] | Guy 2011 [35] | Hafner 1997 [33] | Hodder 2013 [36] | Moran 2012 [34] | Ross 1997 [31] | Desai 2012 [38] | Szerlip 2005 [39] |
---|---|---|---|---|---|---|---|---|---|
OR | % | OR | % | OR | % | OR | % | OR | |
Injected drugs users | 21.1 (4.89–90.9) | 18% | 2.97 (1.77–5.00) | 30% | 2.71 (1.33–5.53) | 10% | 2.3 (1.5–3.5) | ||
Ever smoked crack cocaine | 22.8 (12.6–41.5) | ||||||||
Binge-drinking or alcohol misuse | 1.57* (0.74–3.33) | 12.8 (1.65–99) | |||||||
Substance use (combined)** | 2.52 (1.22–5.21) | 22% | |||||||
Current smokers | 25% | ||||||||
Unsafe sex | 1.84 (1.6– 3.20) | 60% | |||||||
HIV positive partner | 3.24 (1.47–7.11) | ||||||||
Sex with drug user | 17.2 (7.18–40.9) | ||||||||
Contact abroad | 2* | ||||||||
Ever exchanged money or drugs for sex | 19.3 (11.2–33.2) | ||||||||
Male anal sex in the last ≥ 6 months | 1.63 (1.13– 2.35) | ||||||||
Multiple life partners | M: 5.51 (3.18–9.55) F: 19.8 (8.81–44.2) | ||||||||
Obesity | 10% |
Clinical features
Condition | Damery 2013 [17] | Joore 2015 [42] | Hafner 1997 [33] | Marder 1995 [44] | Burchell 2003 [41] | Szerlip 2005 [39] | Krauskopf 2011 [45] | Landau 1997 [43] | Hodder 2013 [36] | Guy 2011 [35] | Ellerbrock 2004 [30] | ||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|
OR (CI) | OR (CI) | % | OR | % & OR | OR | % | % | OR | OR | OR | |||
Clinical features | |||||||||||||
Weight loss | 13.4 (5.15–6.7) | 39.6 (6.2–∞) | |||||||||||
Fever or chills | 4.5* (0.5–54.3) | 13% | |||||||||||
Cough | 7% | ||||||||||||
Flu-like symptoms | 76% | ||||||||||||
Diarrhoea | 2* (0.2–17.4) | ||||||||||||
Diarrhoea consultation | one only | 3.7* (0.9–5.48) | |||||||||||
Diarrhoea consultation | two | 4.4 (2.3–2.81) | |||||||||||
Abdominal pain | 5% | ||||||||||||
Minor trauma | 6% | ||||||||||||
Nausea/vomiting | 6% | ||||||||||||
Rash | 4.5 | ||||||||||||
Number of HIV indicator conditions | One | 11.7 (6–23.6) | |||||||||||
Two | 77.5 (18.2–700.8) | ||||||||||||
Comorbidities | |||||||||||||
Respiratory | Pneumonia | 47.7 (3.54–52) | 8.3 (2–49.8) | ||||||||||
Pneumocystis carinii | 52% | ||||||||||||
Dermatology | Psoriasis | 2.9* (0.1–∞) | |||||||||||
Psoriasis—one consultation only | 2.6 (1.69–1.5) | ||||||||||||
Psoriasis—two consultations | 3 (1.38–2.5) | ||||||||||||
Herpes zoster | 25.4 (5.76–14.2) | 10.9 (2–108.9) | |||||||||||
Neurology | Peripheral neuropathy | 15.9 (2–∞) | |||||||||||
Neurologic disability in women | 2.4 | ||||||||||||
Neurologic disability in men | 1.9 (1.1–3.2) | ||||||||||||
Gastroenterology | Oral candidiasis | 29.4 (4.57–21.8) | 7.1* (0.6–∞) | ||||||||||
Hepatitis B | 11.5 (1.2–∞) | 8.3 (2.65–26.2) | |||||||||||
Chronic liver disease | 22% (15%–29%) | ||||||||||||
Oncology | Non-Hodgkin’s lymphoma | 12.6 (2.13–15) | |||||||||||
Lymphogranuloma venereum | 7.1* (0.6–∞) | ||||||||||||
Gynaecology | Cervical dysplasia | 2.9* (0.4–232.4) | |||||||||||
Condyloma acuminata | 12.1 (1.2–600.9) | ||||||||||||
Haematology | Leucocytopenia | 11.5 (1.2–∞) | |||||||||||
Blood dyscrasia | 5.7 (2.44–4) | ||||||||||||
ENT | Lymphadenopathy | 11.3 (5.15–5.3) | 29.8 (4.4–∞) | ||||||||||
Parotitis | 8.6 (1.68–11) | ||||||||||||
Other | Mononucleosis-like illness | 6.2 (1.6–29) | |||||||||||
Pyrexia of unknown origin | 7.2 (4.05–3.5) | ||||||||||||
Hyperlipidemia | 25% (17%–32%) | ||||||||||||
Hypertension | 10% (4%–16%) | ||||||||||||
Diabetes | 10% (5%–14%) | ||||||||||||
Sexually Transmitted Infection (STI) | 10.8 (3.38–7.6) | 10.1 (3.39–30.12) | 10.1 (6.89–14.9) | ||||||||||
STI diagnosis | ≤ 2 years | 2.72 (1.77–4.2) | |||||||||||
≤ 14 days | 3.19 (2.05–4.96) | ||||||||||||
Number of STIs per patient | One | 14.6 (5.5–45.6) | |||||||||||
≥ 2 | 37.9 (5.6-∞) | ||||||||||||
Syphilis | 39.3 (5.7–1703.9) | 7.35 (2.52–21.5) | 12.7 (7.28–22.3) | ||||||||||
Seropositive for syphilis* | 7.29 (4.15–12.8) | ||||||||||||
Infectious Syphilis diagnosis | ≤ 2 years | 3.86 (1.99–7.5) | |||||||||||
≤ 14 days | 4.9 (2.51–9.56) | ||||||||||||
Chlamydia | 11.8 (3–67.5) | ||||||||||||
Chlamydia diagnosis | ≤ 2 years | 2.31 (1.4–3.81) | |||||||||||
≤ 14 days | 2.62 (1.56–4.39) | ||||||||||||
Gonorrhoea | 15.9 (2–∞) | 6.51 (4.4–9.65) | |||||||||||
Genital herpes | 2.9* (0.1–∞) |
Comorbidities associated with HIV
Discussion
Category of predictor | Predictor of HIV infection | Likelihood of being recorded in primary care records |
---|---|---|
Sociodemographic | Age | Present for all patients |
Gender | Present for all patients | |
Social status | Inferred from postcode | |
Poverty index | Present as deprivation quintile | |
Annual income | Inferred from prescription payments, benefits | |
Employment status | Likely to be poorly recorded | |
Sexual orientation | Require further investigation | |
Not a high school graduate | Not present | |
Country of birth | Not present | |
Ethnicity | Present for some patients | |
Behavioural | Smoking status | Very likely to be present |
Drug use | Present for some patients | |
Binge-drinking or alcohol misuse | Present for some patients | |
Obesity | Very likely to be present | |
Contact abroad | Might be present | |
Stressful events | Present for some patients | |
Unsafe sex | Likely not present | |
Ever exchanged money or drugs for sex | Likely not present | |
Male anal sex | Likely not present | |
Number of lifetime partners | Likely not present | |
Partner characteristics | Likely not present | |
Clinical and comorbid conditions | Weight loss | Likely to be present |
Fever or chills | Likely to be present | |
Cough | Likely to be present | |
Flu like symptoms | Likely to be present | |
Diarrhoea | Likely to be present | |
Abdominal pain | Likely to be present | |
Minor trauma | Likely to be present | |
Nausea/vomiting | Likely to be present | |
Rash | Likely to be present | |
Pneumonia | Likely to be present | |
Pneumocystis carinii | Likely to be present | |
Psoriasis | Likely to be present | |
Herpes zoster | Likely to be present | |
Peripheral neuropathy | Likely to be present | |
Neurologic disability | Likely to be present | |
Oral candidiasis | Likely to be present | |
Hepatitis B | Likely to be present | |
Chronic liver disease | Likely to be present | |
Non-Hodgkin’s lymphoma | Likely to be present | |
Condyloma acuminata | Likely to be present | |
Leucocytopenia | Likely to be present | |
Blood dyscrasia | Likely to be present | |
Lymphadenopathy | Likely to be present | |
Parotitis | Likely to be present | |
Mononucleosis-like illness | Likely to be present | |
Pyrexia of unknown origin | Likely to be present | |
Hyperlipidemia | Likely to be present | |
Hypertension | Likely to be present | |
Diabetes | Likely to be present | |
Sexually transmitted infection | Likely to be present | |
Syphilis | Likely to be present | |
Chlamydia | Likely to be present | |
Gonorrhoea | Likely to be present | |
Genital herpes | Likely to be present |