{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,26]],"date-time":"2026-10-26T22:03:03Z","timestamp":1793052183549,"version":"4.5.0"},"reference-count":87,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2025,11,7]],"date-time":"2025-11-07T00:00:00Z","timestamp":1762473600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medical Sciences"],"abstract":"<jats:p>Purpose: The COVID-19 pandemic has led to the publication of numerous primary studies and meta-analyses; however, conclusive evidence on whether HIV infection influences COVID-19 outcomes among people living with HIV (PLHIV) is still lacking. This research uses a novel technique, the exit meta-analysis, to conclusively update the evidence of HIV\u2019s impact on COVID-19-related mortality, hospitalization, and need for Intensive Care Unit (ICU) admission in severe disease. Methods: A search of PubMed, EMBASE, Cochrane Reviews (CDSR), SCOPUS, CINAHL reviews and Google Scholar databases was conducted up to the 18 January 2024 for meta-analyses and observational studies that reported adjusted associations for the effect of HIV on COVID-19 related mortality, hospitalization, and ICU admission. Evidence from existing meta-analyses was summarized narratively, and an updated meta-analysis was carried out using a bias-adjusted inverse variance heterogeneity model. Subgroup analysis was carried out for age groups and geographical regions. Results: Of 3153 records identified, 20 meta-analyses and 56 primary studies, with a total of 27,936,428 participants, including 655,882 PLHIV, were included. A review of the meta-analyses showed conflicting results for all outcomes. In the updated synthesis, HIV was associated with higher odds of mortality (aOR 1.43, 95% CI: 1.01\u20131.86, I2 = 90.7%) and ICU admission (aOR 1.49, 95% CI: 0.67\u20132.30, I2 = 88.8%), but not hospitalization (aOR 1.11, 95% CI: 0.78\u20131.48, I2 = 97.5%). The results for both ICU admission and hospitalization include the null value, leading to lower certainty. The exit meta-analysis suggested conclusive results for mortality (DAts score = \u22120.012) and hospitalization (DAts score = \u22120.014), but not for ICU admission. Conclusions: This exit meta-analysis provides conclusive evidence that HIV increases mortality in people with COVID-19; however, more studies may be required to address ICU admission and hospitalization.<\/jats:p>","DOI":"10.3390\/medsci13040261","type":"journal-article","created":{"date-parts":[[2025,11,7]],"date-time":"2025-11-07T10:56:45Z","timestamp":1762513005000},"page":"261","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Exit Meta-Analysis on the Effect of HIV on COVID-19 Mortality, Hospitalization, and ICU Admission"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1082-7557","authenticated-orcid":false,"given":"Lubna A.","family":"Zar","sequence":"first","affiliation":[{"name":"Department of Population Medicine, College of Medicine, QU Health, Qatar University, Doha P.O. Box 2713, Qatar"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-9892-0993","authenticated-orcid":false,"given":"Shahd","family":"Hamran","sequence":"additional","affiliation":[{"name":"Department of Population Medicine, College of Medicine, QU Health, Qatar University, Doha P.O. Box 2713, Qatar"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Izzaldin","family":"Alremawi","sequence":"additional","affiliation":[{"name":"Department of Population Medicine, College of Medicine, QU Health, Qatar University, Doha P.O. Box 2713, Qatar"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamed","family":"Elahtam","sequence":"additional","affiliation":[{"name":"Department of Population Medicine, College of Medicine, QU Health, Qatar University, Doha P.O. Box 2713, Qatar"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Asmaa","family":"Abdelmaksoud","sequence":"additional","affiliation":[{"name":"Hamad Medical Corporation, Doha P.O. Box 3050, Qatar"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rida","family":"Arif","sequence":"additional","affiliation":[{"name":"Hamad Medical Corporation, Doha P.O. Box 3050, Qatar"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6621-6144","authenticated-orcid":false,"given":"Tawanda","family":"Chivese","sequence":"additional","affiliation":[{"name":"Department of Science and Mathematics, School of Interdisciplinary Arts and Sciences, University of Washington Tacoma, Tacoma, WA 98402, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,11,7]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"86","DOI":"10.1016\/S0140-6736(09)60329-9","article-title":"Avoidable waste in the production and reporting of research evidence","volume":"374","author":"Chalmers","year":"2009","journal-title":"Lancet"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"267","DOI":"10.1016\/S0140-6736(13)62228-X","article-title":"Reducing waste from incomplete or unusable reports of biomedical research","volume":"383","author":"Glasziou","year":"2014","journal-title":"Lancet"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"485","DOI":"10.1111\/1468-0009.12210","article-title":"The Mass Production of Redundant, Misleading, and Conflicted Systematic Reviews and Meta-analyses","volume":"94","author":"Ioannidis","year":"2016","journal-title":"Milbank Q."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"156","DOI":"10.1016\/S0140-6736(13)62229-1","article-title":"How to increase value and reduce waste when research priorities are set","volume":"383","author":"Chalmers","year":"2014","journal-title":"Lancet"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"166","DOI":"10.1016\/S0140-6736(13)62227-8","article-title":"Increasing value and reducing waste in research design, conduct, and analysis","volume":"383","author":"Ioannidis","year":"2014","journal-title":"Lancet"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1412","DOI":"10.4102\/sajhivmed.v24i1.1412","article-title":"COVID-19 severity and in-hospital mortality in an area with high HIV prevalence","volume":"24","author":"Boswell","year":"2023","journal-title":"S. 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