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

摘要

BackgroundDiarrhea 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. MethodsWe 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. ResultsOur 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. ConclusionsOur 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.