Prevalence of HIV-associated esophageal candidiasis in sub-Saharan Africa: a systematic review and meta-analysis
Abstract Background Esophageal 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 an...
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| Format: | Article |
| Language: | English |
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BMC
2020-09-01
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| Series: | Tropical Medicine and Health |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s41182-020-00268-x |
| _version_ | 1818400557974421504 |
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| author | Ronald Olum Joseph Baruch Baluku Ronald Okidi Irene Andia-Biraro Felix Bongomin |
| author_facet | Ronald Olum Joseph Baruch Baluku Ronald Okidi Irene Andia-Biraro Felix Bongomin |
| author_sort | Ronald Olum |
| collection | DOAJ |
| description | Abstract Background Esophageal 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). Methods We 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. Results Thirteen 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%, I 2 = 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). Conclusion The 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. |
| first_indexed | 2024-12-14T07:38:29Z |
| format | Article |
| id | doaj.art-f1e0485a01d74afd98eafdee9781d3a4 |
| institution | Directory Open Access Journal |
| issn | 1349-4147 |
| language | English |
| last_indexed | 2024-12-14T07:38:29Z |
| publishDate | 2020-09-01 |
| publisher | BMC |
| record_format | Article |
| series | Tropical Medicine and Health |
| spelling | doaj.art-f1e0485a01d74afd98eafdee9781d3a42022-12-21T23:11:07ZengBMCTropical Medicine and Health1349-41472020-09-0148111010.1186/s41182-020-00268-xPrevalence of HIV-associated esophageal candidiasis in sub-Saharan Africa: a systematic review and meta-analysisRonald Olum0Joseph Baruch Baluku1Ronald Okidi2Irene Andia-Biraro3Felix Bongomin4School of Medicine, College of Health Sciences, Makerere UniversityDirectorate of Programs, Mildmay UgandaDepartment of General Surgery, St. Mary’s Hospital – LacorDepartment of Medicine, School of Medicine, College of Health Sciences, Makerere UniversityDepartment of Medicine, School of Medicine, College of Health Sciences, Makerere UniversityAbstract Background Esophageal 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). Methods We 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. Results Thirteen 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%, I 2 = 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). Conclusion The 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.http://link.springer.com/article/10.1186/s41182-020-00268-xEsophageal candidiasisPrevalenceHIV/AIDSSub-Saharan AfricaReviewMeta-analysis |
| spellingShingle | Ronald Olum Joseph Baruch Baluku Ronald Okidi Irene Andia-Biraro Felix Bongomin Prevalence of HIV-associated esophageal candidiasis in sub-Saharan Africa: a systematic review and meta-analysis Tropical Medicine and Health Esophageal candidiasis Prevalence HIV/AIDS Sub-Saharan Africa Review Meta-analysis |
| title | Prevalence of HIV-associated esophageal candidiasis in sub-Saharan Africa: a systematic review and meta-analysis |
| title_full | Prevalence of HIV-associated esophageal candidiasis in sub-Saharan Africa: a systematic review and meta-analysis |
| title_fullStr | Prevalence of HIV-associated esophageal candidiasis in sub-Saharan Africa: a systematic review and meta-analysis |
| title_full_unstemmed | Prevalence of HIV-associated esophageal candidiasis in sub-Saharan Africa: a systematic review and meta-analysis |
| title_short | Prevalence of HIV-associated esophageal candidiasis in sub-Saharan Africa: a systematic review and meta-analysis |
| title_sort | prevalence of hiv associated esophageal candidiasis in sub saharan africa a systematic review and meta analysis |
| topic | Esophageal candidiasis Prevalence HIV/AIDS Sub-Saharan Africa Review Meta-analysis |
| url | http://link.springer.com/article/10.1186/s41182-020-00268-x |
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