Prevalence of Cryptosporidium, microsporidia and Isospora infection in HIV-infected people: a global systematic review and meta-analysis

Wang, Z. D. and Liu, Q. and Liu, H. H. and Li, S. and Zhang, L. and Zhao, Y. K. and Zhu, X. Q.

Parasit Vectors (2018) 11: 28

DOI: 10.1186/s13071-017-2558-x

Abstract

BACKGROUND: Diarrhea caused by opportunistic intestinal protozoa is a common problem in HIV infection. We aimed to establish the prevalence of Cryptosporidium, misrosporidia, and Isospora in HIV-infected people using a systematic review and meta-analysis, which is central to developing public policy and clinical services. METHODS: We searched PubMed, ScienceDirect, Google Scholar, Embase, Chinese Web of Knowledge, Wanfang, and Chongqing VIP databases for studies reporting Cryptosporidium, microsporidia, or Isospora infection in HIV-infected people. We extracted the numbers of people with HIV and protozoa infection, and estimated the pooled prevalence of parasite infection by a random effects model. RESULTS: Our research identified 131 studies that reported Cryptosporidium, microsporidia, and Isospora infection in HIV-infected people. We estimated the pooled prevalence to be 14.0% (3283/43,218; 95% CI: 13.0-15.0%) for Cryptosporidium, 11.8% (1090/18,006; 95% CI: 10.1-13.4%) for microsporidia, and 2.5% (788/105,922; 95% CI: 2.1-2.9%) for Isospora. A low prevalence of microsporidia and Isospora infection was found in high-income countries, and a high prevalence of Cryptosporidium and Isospora infection was found in sub-Saharan Africa. We also detected a high prevalence of Cryptosporidium, microsporidia, and Isospora infection in patients with diarrhea. Sensitivity analysis showed that three studies significantly affect the prevalence of Isospora, which was adjusted to 5.0% (469/8570; 95% CI: 4.1-5.9%) by excluding these studies. CONCLUSIONS: Our findings suggest that HIV-infected people have a high prevalence of Cryptosporidium, microsporidia, and Isospora infection in low-income countries and patients with diarrhea, especially in sub-Saharan Africa, reinforcing the importance of routine surveillance for opportunistic intestinal protozoa in HIV-infected people.

Citation

Wang, Z. D., Liu, Q., Liu, H. H., Li, S., Zhang, L., Zhao, Y. K., & Zhu, X. Q. (2018). Prevalence of Cryptosporidium, microsporidia and Isospora infection in HIV-infected people: a global systematic review and meta-analysis. Parasit Vectors, 11(1), 28. https://doi.org/10.1186/s13071-017-2558-x Humans, *Meta-analysis, Global Health, Prevalence, interests. PUBLISHER’S NOTE: Springer Nature remains neutral with regard to, jurisdictional claims in published maps and institutional affiliations., Not applicable. COMPETING INTERESTS: The authors declare that they have no competing, *Cryptosporidium, Diarrhea/epidemiology/parasitology, Cryptosporidiosis/*epidemiology, *hiv, *Isospora, *Microsporidia, HIV Infections/*complications, Isosporiasis/*epidemiology, Microsporidiosis/*epidemiology

Keywords

• Humans
• *Meta-analysis
• Global Health
• Prevalence
• interests. PUBLISHER’S NOTE: Springer Nature remains neutral with regard to
• jurisdictional claims in published maps and institutional affiliations.
• Not applicable. COMPETING INTERESTS: The authors declare that they have no competing
• *Cryptosporidium
• Diarrhea/epidemiology/parasitology
• Cryptosporidiosis/*epidemiology
• *hiv
• *Isospora
• *Microsporidia
• HIV Infections/*complications
• Isosporiasis/*epidemiology
• Microsporidiosis/*epidemiology