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Meta-Analysis
. 2016 Sep 9;16(1):482.
doi: 10.1186/s12879-016-1809-3.

Burden of pneumocystis pneumonia in HIV-infected adults in sub-Saharan Africa: a systematic review and meta-analysis

Sean Wasserman  1 , Mark E Engel  2 , Rulan Griesel  3 , Marc Mendelson  4
Affiliations
Meta-Analysis

Burden of pneumocystis pneumonia in HIV-infected adults in sub-Saharan Africa: a systematic review and meta-analysis

Sean Wasserman et al. BMC Infect Dis. .

Abstract

Background: Seroprevalence data and clinical studies in children suggest that the burden of pneumocystis pneumonia (PCP) in Africa may be underestimated. We performed a systematic review to determine the prevalence and attributable mortality of PCP amongst HIV-infected adults in sub-Saharan Africa.

Methods: We searched Pubmed, Web of Science, Africa-Wide: NiPAD and CINAHL, from Jan 1 1995 to June 1 2015, for studies that reported the prevalence, mortality or case fatality of PCP in HIV-infected adults living in sub-Saharan African countries. Prevalence data from individual studies were combined by random-effects meta-analysis according to the Mantel-Haenszel method. Data were stratified by clinical setting, diagnostic method, and study year.

Results: We included 48 unique study populations comprising 6884 individuals from 18 countries in sub-Saharan Africa. The pooled prevalence of PCP among 6018 patients from all clinical settings was 15 · 4 % (95 % CI 12 · 9-18 · 0), and was highest amongst inpatients, 22 · 4 % (95 % CI 17 · 2-27 · 7). More cases were identified by bronchoalveolar lavage, 21 · 0 % (15 · 0-27 · 0), compared with expectorated, 7 · 7 % (4 · 4-11 · 1), or induced sputum, 11 · 7 % (4 · 9-18 · 4). Polymerase chain reaction (PCR) was used in 14 studies (n = 1686). There was a trend of decreasing PCP prevalence amongst inpatients over time, from 28 % (21-34) in the 1990s to 9 % (8-10) after 2005. The case fatality rate was 18 · 8 % (11 · 0-26 · 5), and PCP accounted for 6 · 5 % (3 · 7-9 · 3) of study deaths.

Conclusions: PCP is an important opportunistic infection amongst HIV-infected adults in sub-Saharan Africa, particularly amongst patients admitted to hospital. Although prevalence appears to be decreasing, improved access to antiretroviral therapy and non-invasive diagnostics, such as PCR, are needed.

Keywords: HIV-associated opportunistic infection; PCP; Pneumocystis pneumonia; Respiratory disease in HIV.

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Figures

Fig. 1
Fig. 1
PRISMA flow diagram
Fig. 2
Fig. 2
Pooled prevalence of PCP across all clinical settings
Fig. 3
Fig. 3
Forest plots of proportion of patients with PCP by clinical setting, mortality and time period (a) and by diagnostic method (b). PM post mortem, resp respiratory BAL bronchoalveolar lavage, PCR polymerase chain reaction, Exp expectorated, Ind induced. Heterogeneity: A: Clinical Setting, p < 0.1; I2 = 99.4 %; Mortality, p = 0.83; I2 = 0.0 %; Time Period, p < 0.1; I2 = 91.8 %. B: BAL, p = 0.62; I2 = 0.0 %; expectorated sputum, p = 0.51; I2 = 0.0 %; induced sputum, p < 0.1; I2 = 71.9 %
See this image and copyright information in PMC

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