Results from an umbrella review of observational studies showed highly suggestive or suggestive evidence for HIV and the presence of several physical health outcomes such as chronic obstructive pulmonary disease (COPD), ischemic heart disease, pregnancy-related mortality, maternal sepsis, and bone fractures.

The review was published in Clinical Infectious Diseases and included 20 studies, covering 55 health outcomes which had a median of 18,743 (range 403-225,000,000) participants.

Nominally significant summary results were reported in 45 of the 55 unique outcomes (P <.05). Five outcomes had suggestive evidence with P values <10–3. This was suggestive of a higher likelihood of the presence of breathlessness, higher COPD prevalence, maternal sepsis, higher risk for anemia, and higher risk for all fractures among people living with HIV (PLWHIV). Three outcomes showed stronger evidence using a stringent P value < 10–6. This was associated with a higher prevalence of cough in cross-sectional studies, a higher incidence of pregnancy-related mortality, and a higher incidence of ischemic heart disease among PLWHIV in cohort studies.

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Investigators noted that while umbrella reviews provide important insights and evidence, the meta-analysis contained studies differing in design, populations, and other characteristics. There are inherent limitations to these types of analysis because the findings depend on which estimates are selected from each primary study and how they are applied in the meta-analysis. Further, many of the studies in the review used self-reporting to determine HIV status, but the agreement between self-reports and biohumoral diagnoses is often poor.

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The results demonstrated highly suggestive and suggestive evidence for links between HIV and the presence of coughs, prevalence of COPD, incidence of ischemic heart disease, incidence of pregnancy-related mortality, incidence of maternal sepsis, and risk for bone fractures. Investigators recommend that policies, “reflect and accommodate these changes, especially in light of the increases in both life expectancy and incidences of comorbidities in this population.” They also stated that the elevated risks for the reported outcomes require more research to improve early detection and prevention of these comorbidities in PLWHIV.


Grabovac I, Veronese N, Stefanac S, et al. Human immunodeficiency virus infection and diverse physical health outcomes: an umbrella review of meta-analyses of observational studies [published online August 11 2019]. Clin Infect Dis. doi:10.1093/cid/ciz539