Cryptosporidium infection among people living with HIV/AIDS in Ethiopia: a systematic review and meta-analysis

Abstract

Studies on the prevalence of Cryptosporidium infection in People Living with HIV/AIDS (PLWHA) are inconsistent and heterogeneous. Therefore, this systematic review with meta-analysis was performed to assess the burden of the infection relative to the proportion of CD4 + T cell count among PLWHA in Ethiopia. Articles published before 15 May 2019, have been retrieved for this systematic review using five databases; PubMed, Scopus, Web of Science, Google Scholar and ProQuest, supplemented by the search for gray literature. The overall pooled prevalence and pooled Odds Ratio (OR) with their 95% Confidence Intervals (CI) were estimated using STATA 14 statistical Software. Of the 255 studies retrieved, 31 were considered for the final analysis. As many as 8,645 Ethiopians infected with HIV were included in the final quantitative synthesis. The overall pooled prevalence estimate of Cryptosporidium infection among PLWHA in Ethiopia was 11% (95%CI: 0.09-0.13). HIV-infected people with low CD4 + T cell count (CD4 < 200 cells/mm3) were 13.07 times more likely to become infected with Cryptosporidium than those with high CD4 + T cell count (CD4 > 500 cells/mm3) (OR: 13.07 (95%CI: 6.38-26.75). Cryptosporidium infection in PLWHA in Ethiopia showed decreasing patterns in 2001-2010, 2011-2014, and in 2015-2019, 14.6% (95%CI: 0.076-0.217), 12.71% (95%CI: 0.086-0.167) and 6.7% (95%CI: 0.044-0.090), respectively (p < 0.001). Though the pattern of Cryptosporidium infection in HIV-infected Ethiopians showed a declining trend; it remains a considerable problem that requires improvement in routine screening for Cryptosporidium in HIV-infected people, particularly with poor or declining CD4 + T cell count.

Keywords: CD4+ T cell count; Cryptosporidium; Ethiopia; human Immunodeficiency virus; meta-analysis.

Figure 1.

PRISMA flowchart for selecting eligible studies on the prevalence of cryptosporidiosis among PLWHA and its associations with CD4 + T cell count, in Ethiopia, 2001 to 2019.

Figure 2.

An overall pooled prevalence estimates of cryptosporidiosis in PLWHA in Ethiopia, 2001 to 2019. The X-axis of ES represents a study’s effect size estimate with a point and 95% confidence interval with a horizontal line. The weight (in %) denotes the influence an individual study has had on the pooled outcome. The vertical line is the line of zero prevalence. The diamond block indicates pooled prevalence estimate. P-value (p < 0.001) signifies a statistically significant heterogeneity among studies.

Figure 3.

Forest plot showing the prevalence of cryptosporidiosis among PLWHA in Ethiopia based on diarrhea status, 2001 to 2019. ES indicates a study’s effect size estimate with a point and 95% confidence interval with a horizontal line. The weight (in %) designates the impact an individual study has had on the overall prevalence estimate. The vertical line is the line of null prevalence. The diamond block shows the overall prevalence estimate in Diarrheic and Non-diarrheic patients. P-value (p < 0.001) suggests a statistically significant heterogeneity among studies.

Figure 4.

Forest plot depicting prevalence estimates of cryptosporidiosis in PLWHA in Ethiopia based on diagnosis methods, 2001 to 2019.

Figure 5.

A pooled odds ratio of the correlation between cryptosporidiosis with CD4 + T cell count among Ethiopians infected with HIV, 2001 to 2019. The points on the plot represent the odds ratio (OR) of individual studies and the horizontal line with the points show the confidence interval of individual studies. The vertical axis (OR = 1) denotes the line of no association between cryptosporidiosis with CD4 + T cells count. The diamond block shows the overall pooled odds ratio of correlation between cryptosporidiosis with CD4 + T cells count in PLWHA in Ethiopia. P-value (p > 0.05) signifies a statistically insignificant homogeneity among studies.