The Effect of Malaria and HIV Co-Infection on Anemia: A Meta-Analysis.
The Effect of Malaria and HIV Co-Infection on Anemia: A Meta-Analysis.
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DOI：
10.1097/md.0000000000003205
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发表时间：
2016-04
期刊：
影响因子：
1.6
通讯作者：
Wai VN
中科院分区：
文献类型：
--
作者：
Naing C;Sandhu NK;Wai VN
补充数字内容可在文本中找到疟疾和人类免疫缺陷病毒(艾滋病毒)感染是全球重要的公共卫生问题。这项研究的目的是(I)确定疟疾和艾滋病毒混合感染在流行国家的人群中的流行率，以及(Ii)评估混合感染对贫血的影响。在电子数据库包括PubMed、Embase、Medline、Google Scholar和African Journal Online上搜索这些研究。包括观察性研究，评估合并感染的流行率，并报告其与贫血的相关性。纳入研究的方法学质量是使用一种称为非随机研究偏差风险评估的工具进行评估的。研究间的异质性用i平方检验进行检验。利用随机效应模型估计合并感染的合并流行率及其95%可信区间(CI)，这反映了研究之间的异质性。适当地估计汇总优势比(OR)、汇总标准化平均差值(SMD)及其相应的95%CI。为了保证结果的稳健性，进行了分组分析和Meta回归分析。通过漏斗图的可视化来评估发表的偏倚。本研究共纳入23项研究。总体而言，合并感染率为19%(95%CI：15-23%，I2：98.1%)，成人为26%(95%CI：20-32%，I2：98.7%)，孕妇为12%(95%CI：7-17%，I2：95.0)，儿童为9%(95%CI：6-11%，I2：68.6%)。合并感染的孕妇贫血增加49%(汇总OR：1.49，95%CI：1.14~1.94)。合并感染组的平均血红蛋白浓度显著低于单一感染组(−为0.47，95%CI：−为0.61至−为0.33)。以发表年份和总人口数为协变量对混合感染流行率进行Meta回归分析的结果表明，I2值仍然很高，这意味着实际上是异质性的随机分布。不对称的漏斗图表明存在发表偏见。由于本综述中研究的异质性，对结果的解释必须谨慎。这项研究的结果表明，疟疾和艾滋病毒混合感染的流行率，特别是在孕妇中，需要医护人员特别关注。更好地了解合并感染对于设计治疗策略至关重要。推荐未来评估疟疾和艾滋病毒之间相互作用的强大的、前瞻性的设计。
Supplemental Digital Content is available in the text Malaria and human immunodeficiency virus (HIV) infections are globally important public health concerns. The objectives of this study were (i) to determine the prevalence of malaria and HIV co-infections in people living in endemic countries, and (ii) to assess the effect of co-infection on anemia. Studies were searched on electronic databases including PubMed, Embase, Medline, Google Scholar, and African Journals Online. Observational studies, assessing the prevalence of co-infection and reporting its association with anemia, were included. The methodological quality of included studies was assessed using a tool called the risk of bias assessment for non-randomized studies. Heterogeneity among studies was investigated with the I-square test. Pooled prevalence of the co-infection and its 95% confidence interval (CI) were estimated using the random-effect model, reflected on heterogeneity among studies. Summary odds ratio (OR), summary standardized mean difference (SMD), and their corresponding 95% CIs were estimated, as appropriate. Subgroup analysis and meta-regression were performed for robustness of results. Publication bias was assessed by visualization of a funnel plot. Twenty-three studies were included in the present study. Overall, the pooled prevalence of co-infection was 19% (95% CI: 15–23%, I2: 98.1%), showing 26% (95% CI: 20–32%, I2: 98.7%) in adults, 12% (95% CI: 7–17%, I2: 95.0) in pregnant women, and 9% (95% CI: 6–11%, I2: 68.6%) in children. Anemia was comparable between the monoinfected and co-infected adults (summary OR: 1.49, 95% CI: 0.93–2.37) and increased by 49% in co-infected pregnant women (summary OR: 1.49, 95% CI: 1.14–1.94). The mean hemoglobin concentration was significantly lower in the co-infected group than the monoinfected group (summary SMD: −0.47, 95% CI: −0.61 to −0.33). The results of meta-regression on the prevalence of co-infection using the publication year and total population as covariates showed the I2 value remained high implying a de facto random distribution of heterogeneity. An asymmetrical funnel plot indicated the presence of publication bias. Due to heterogeneity of the studies in this review, the results have to be interpreted with caution. The findings of this study suggest that the prevalence of malaria and HIV co-infection, particularly in pregnant women, requires special attention from healthcare personnel. Better understanding of the co-infection is crucial for designing treatment strategies. Future well-powered, prospective designs assessing the interaction between malaria and HIV are recommended.