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Mortality rates in people dually infected with HIV-1/2 and those infected with either HIV-1 or HIV-2: a systematic review and meta-analysis

Prince, Puck D.a,*; Matser, Amya,b,*; van Tienen, Carlac; Whittle, Hilton C.d; Schim van der Loeff, Maarten F.a,e

doi: 10.1097/01.SPC.0000432532.87841.78
Epidemiology and Social

Objective: As compared to HIV-1 infection, HIV-2 is less transmissible, disease progression is slower, and the mortality risk is lower. It has been suggested that HIV-2 infection inhibits the progression of HIV-1 in individuals dually infected by HIV-1 and HIV-2 (HIV-D). We examined whether the mortality rates in dually infected individuals differ from those in persons infected with either HIV-1 or HIV-2.

Design: We conducted a systematic review and meta-analysis.

Methods: Medline and Embase databases were searched for studies that reported the number of deaths and person-years of observation (PY) for at least two of the three HIV groups (i.e. HIV-1, HIV-2, and HIV-D). Meta-analyses were then performed with random-effects models, estimating combined mortality rate ratios (MRRs).

Results: Of the 631 identified titles, six articles were included in the meta-analysis of HIV-D-infected individuals versus HIV-mono-infected persons, and seven were included in the analysis of HIV-1-mono-infected versus HIV-2-mono-infected individuals. The overall MRR of those infected with HIV-D versus HIV-1 was 1.11 [95% confidence interval (CI) 0.95–1.30]. The overall MRR of those infected with HIV-D versus HIV-2 was 1.81 (95% CI 1.43–2.30) and the MRR of those infected with HIV-1 versus HIV-2 was 1.86 (95% CI 1.44–2.39).

Conclusion: HIV-2-mono-infected persons have a lower mortality rate than those mono-infected with HIV-1 and those with HIV-D. There is no evidence that HIV-2 delays progression to death in HIV-D-infected individuals.

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aCluster of Infectious Diseases, Amsterdam Public Health Service, Amsterdam

bJulius Centre for Health Sciences & Primary Care, University Medical Centre Utrecht, Utrecht

cMedical Microbiology and Infectious Diseases, Erasmus Medical Center, Rotterdam, the Netherlands

dLondon School of Hygiene and Tropical Medicine, London, UK

eCenter for Infection and Immunology Amsterdam, Academic Medical Center, Amsterdam, the Netherlands.

*Puck D. Prince and Amy Matser contributed equally to the writing of this article.

Correspondence to Amy Matser, Public Health Service of Amsterdam, Cluster of Infectious Diseases, Department of Research, Postbox 2200, 1000 CE Amsterdam, The Netherlands. Tel: +31 020 5555362; e-mail.

Received 26 April, 2013

Revised 21 June, 2013

Accepted 27 June, 2013

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