Older adults at high risk of HIV infection in China: a systematic review and meta-analysis of observational studies.

Yuan Yuan Wang,Xiaohua Douglas Zhang,Chang Chen,Yu-Tao Xiang,Ling Zhang,Chee H Ng,Yuan Yang,Gabor S Ungvari

doi:10.7717/peerj.9731

Abstract

There is an increasing prevalence of human immunodeficiency virus (HIV) infection in older adults in China, but the findings across prevalence studies have been mixed. This is the first meta-analysis of the prevalence of HIV infection and its moderating factors in older adults in China. Two investigators systematically and independently searched both international (PubMed, PsycINFO, Web of Sciences and EMBASE) and Chinese (WanFang, CNKI, and CQVIP) databases. HIV infection rates in older adults were analyzed using the random-effects model. Altogether 46 studies were included in the analysis. The pooled prevalence of HIV infection in older adults was 2.1% (95% CI [1.9%–2.3%], I2 = 99.4%). Subgroup analyses revealed that men who have sex with men (MSM), hospital population samples, publications after 2014, studies conducted in the western region of China, and higher study quality were significantly associated with higher HIV infection rate. This meta-analysis found that the HIV infection prevalence in older adults is significantly higher than the general population in China. Attention should be given to this urgent public health issue, and effective HIV/AIDS preventive, screening and treatment measures are warranted in this population. PROSPERO: CRD42019124286.

Highlights

Human Immunodeficiency Virus (HIV) infection is a major public health challenge associated with high disease burden globally (Maartens, Celum & Lewin, 2014)
Nine studies reported the HIV infection rate in all age groups (Chen et al, 2017; Chen et al, 2016; Chen et al, 2013; Du & Meng, 2016; Feng et al, 2009; Wang et al, 2018a; Zhao, Su & Jiang, 2015; Zhong et al, 2017; Zhu, Miu & Zhang, 2014), only data in older adults were extracted for analyses; while five studies focused on older men who have sex with men (MSM) adults
The Duval and Tweedie trim-and-fill analysis suggests that 8 studies would need to be imputed to achieve an approximate normal error distribution. Including these 8 studies could lead to a lower prevalence of 0.096. This was the first meta-analysis to examine the prevalence of HIV infection in older adults in China

Summary

Introduction

Human Immunodeficiency Virus (HIV) infection is a major public health challenge associated with high disease burden globally (Maartens, Celum & Lewin, 2014). Older adults at high risk of HIV infection in China: a systematic review and meta-analysis of observational studies. Those who are at high risk of HIV infection include men who have sex with men (MSM) and younger adults (Knudson et al, 2018; Zhang et al, 2017b). A study in Chongqing, China found that the number of newly HIV infected persons aged over 50 years has increased six-fold from 1,091 in 2004 to 6,352 in 2015 (Zhang, Rongrong & Guohui, 2017a)

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