Prevalence of HIV-associated esophageal candidiasis in sub-Saharan Africa: a systematic review and meta-analysis

Tropical Medicine and Health

Ronald Okidi¹  Felix Bongomin²  Irene Andia-Biraro³  Joseph Baruch Baluku⁴  Ronald Olum⁵ 

[1] Department of General Surgery, St. Mary’s Hospital – Lacor, Gulu, Uganda;Department of Medicine, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda;Department of Medical Microbiology and Immunology, Faculty of Medicine, Gulu University, Gulu, Uganda;Department of Medicine, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda;Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda;Directorate of Programs, Mildmay Uganda, Wakiso, Uganda;Division of Pulmonology, Mulago National Referral Hospital, Kampala, Uganda;School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda;

关键词: Esophageal candidiasis;    Prevalence;    HIV/AIDS;    Sub-Saharan Africa;    Review;    Meta-analysis;   

DOI  :  10.1186/s41182-020-00268-x

来源: Springer

【 摘 要 】

BackgroundEsophageal candidiasis (OC) is a common AIDS-defining opportunistic infection. Antiretroviral therapy (ART) reduces the occurrence of OC and other opportunistic infections among persons living with HIV (PLHIV). We sought to determine and compare the prevalence of OC in the ART and pre-ART era among PLHIV in sub-Saharan Africa (SSA).MethodsWe searched PubMed, Embase, Web of Science, and the African Journals Online databases to select studies in English and French reporting the prevalence of HIV-associated OC in SSA from January 1980 to June 2020. Reviews, single-case reports, and case series reporting < 10 patients were excluded. A random-effect cumulative meta-analysis was performed using STATA 16.0, and trend analysis performed using GraphPad Prism 8.0.ResultsThirteen eligible studies from 9 SSA countries including a total of 113,272 patients were qualitatively synthesized, and 9 studies were included in the meta-analysis. Overall pooled prevalence of HIV-associated OC was 12% (95% confidence interval (CI): 8 to 15%, I2 = 98.61%, p <. 001). The prevalence was higher in the pre-ART era compared to the ART era, but not to statistical significance (34.1% vs. 8.7%, p = 0.095). In those diagnosed by endoscopy, the prevalence was higher compared to patients diagnosed by non-endoscopic approaches, but not to statistical significance (35.1% vs. 8.4%, p = .071). The prevalence of OC significantly decreased over the study period (24 to 16%, p < .025).ConclusionThe prevalence of OC among PLHIV in the ART era in SSA is decreasing. However, OC remains a common problem. Active endoscopic surveillance of symptomatic patients and further empirical studies into the microbiology, optimal antifungal treatment, and impact of OC on quality of life of PLHIV in SSA are recommended.

【 授权许可】

CC BY