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.
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.


METHODS
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).


CONCLUSIONS
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.
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.
Puck D
PD
Prince
Amy
A
Matser
Carla
C
van Tienen
Hilton C
HC
Whittle
Maarten F
MF
Schim van der Loeff
D000293:Adolescent; D000328:Adult; D000368:Aged; D060085:Coinfection / Q000401:mortality* / Q000821:virology*; D005260:Female; D015658:HIV Infections / Q000401:mortality* / Q000821:virology*; D015497:HIV-1 / Q000302:isolation & purification*; D015498:HIV-2 / Q000302:isolation & purification*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009026:Mortality; D016019:Survival Analysis; D055815:Young Adult