Prevalence of HIV-associated esophageal candidiasis in sub-Saharan Africa: a systematic review and meta-analysis
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Date
2020
Journal Title
Journal ISSN
Volume Title
Publisher
Tropical Medicine and Health
Abstract
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%, 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).
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.
Description
Keywords
Esophageal candidiasis, Prevalence, HIV/AIDS, Sub-Saharan Africa, Review, Meta-analysis
Citation
Olum, R., Baluku, J. B., Okidi, R., Andia-Biraro, I., & Bongomin, F. (2020). Prevalence of HIV-associated esophageal candidiasis in sub-Saharan Africa: a systematic review and meta-analysis. Tropical Medicine and Health, 48(1), 1-10. https://doi.org/10.1186/s41182-020-00268-x