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Prevalence and incidence of pulmonary hypertension among HIV-infected people in Africa: a systematic review and meta-analysis.

Prevalence and incidence of pulmonary hypertension among HIV-infected people in Africa: a systematic review and meta-analysis.
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Bigna JJ, Nansseu JR, Um LN, Noumegni SR, Simé PS, Aminde LN, Koulla-Shiro S, Noubiap JJ,


Bigna JJ, Nansseu JR, Um LN, Noumegni SR, Simé PS, Aminde LN, Koulla-Shiro S, Noubiap JJ, (click to view)

Bigna JJ, Nansseu JR, Um LN, Noumegni SR, Simé PS, Aminde LN, Koulla-Shiro S, Noubiap JJ,

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BMJ open 2016 08 236(8) e011921 doi 10.1136/bmjopen-2016-011921

Abstract
OBJECTIVE
Patients infected with HIV have a direly increased risk of developing pulmonary hypertension (PH), and of dying from the condition. While Africa carries the greatest burden of HIV infection worldwide, there is unclear data summarising the epidemiology of PH among HIV-infected people in this region. Our objective was to determine the prevalence and incidence of PH among HIV-infected people living across Africa.

DESIGN
A systematic review and meta-analysis.

PARTICIPANTS
HIV-infected African people residing in Africa.

OUTCOME
Prevalence and incidence of PH diagnosed through echocardiography or right heart catheterisation.

DATA SOURCES
Articles published in PubMed/MEDLINE, EMBASE, African Journals Online and African Index Medicus between 1 January 1980 and 30 June 2016, without any language restriction.

RESULTS
Overall, 121 studies were screened; 3 were included in this review: 1 from Southern Africa (South Africa), 1 from Eastern Africa (Tanzania) and 1 from Central Africa (Cameroon). These studies included HIV-infected adult patients selected based on presentation with cardiovascular symptoms. No study reported PH incidence or PH incidence/prevalence among children and adolescents. The quality assessment yielded moderate risk of bias. Ages of participants ranged between 18 and 78 years, and the proportion of females varied between 52.3% and 68.8%. The prevalence of PH in the pooled sample of 664 patients was 14% (95% CI 6%-23%).

LIMITATIONS
Only 3 studies were found eligible from 3 regions of the African continent.

CONCLUSIONS
The prevalence of PH among HIV-infected people in Africa seems very high. Further studies are urgently warranted to determine the incidence of HIV-induced PH, which must include all subregions of Africa.

TRIAL REGISTRATION NUMBER
Review registration number PROSPERO CRD42016033863.

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