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Meta-Analysis
. 2020:27:27.
doi: 10.1051/parasite/2020025. Epub 2020 Apr 30.

Cryptosporidiosis in HIV-positive patients and related risk factors: A systematic review and meta-analysis

Ehsan Ahmadpour  1 , Hanie Safarpour  2 , Lihua Xiao  3 , Mehdi Zarean  4 , Kareem Hatam-Nahavandi  5 , Aleksandra Barac  6 , Stephane Picot  7 , Mohammad Taghi Rahimi  8 , Salvatore Rubino  9 , Mahmoud Mahami-Oskouei  10 , Adel Spotin  11 , Sanam Nami  12 , Hossein Bannazadeh Baghi  13
Affiliations
Meta-Analysis

Cryptosporidiosis in HIV-positive patients and related risk factors: A systematic review and meta-analysis

Ehsan Ahmadpour et al. Parasite. 2020.

Abstract
in English, French

Cryptosporidium is one of the major causes of diarrhea in HIV-positive patients. The aim of this study is to systematically review and meta-analyze the prevalence of Cryptosporidium in these patients. PubMed, Science Direct, Google Scholar, Web of Science, Cochrane and Ovid databases were searched for relevant studies dating from the period of 1 January 2000 to 31 December 2017. Data extraction for the included studies was performed independently by two authors. The overall pooled prevalence was calculated and subgroup analysis was performed on diagnostic methods, geographical distribution and study population. Meta-regression was performed on the year of publication, proportion of patients with diarrhea, and proportion of patients with CD4 < 200 cells/mL. One hundred and sixty-one studies and 51,123 HIV-positive participants were included. The overall pooled prevalence of Cryptosporidium infection in HIV-positive patients was 11.2% (CI95%: 9.4%-13.0%). The pooled prevalence was estimated to be 10.0% (CI95%: 8.4%-11.8%) using staining methods, 13.5% (CI95%: 8.9%-19.8%) using molecular methods, and 26.3% (CI95%: 15.0%-42.0%) using antigen detection methods. The prevalence of Cryptosporidium in HIV patients was significantly associated with the country of study. Also, there were statistical differences between the diarrhea, CD4 < 200 cells/mL, and antiretroviral therapy risk factors with Cryptosporidiosis. Thus, Cryptosporidium is a common infection in HIV-positive patients, and safe water and hand-hygiene should be implemented to prevent cryptosporidiosis occurrence in these patients.

Title: Cryptosporidiose chez les patients VIH-séropositifs et facteurs de risque associés : revue systématique et méta-analyse.

Abstract: Cryptosporidium est l’une des principales causes de diarrhée chez les patients séropositifs pour le VIH. Le but de cette étude est de revoir et méta-analyser systématiquement la prévalence de Cryptosporidium chez ces patients. Les bases de données PubMed, Science Direct, Google Scholar, Web of Science, Cochrane et Ovid ont été recherchées pour des études pertinentes datant du 1er janvier 2000 au 31 décembre 2017. L’extraction des données pour les études incluses a été réalisée indépendamment par deux auteurs. La prévalence globale combinée a été calculée et une analyse en sous-groupes a été effectuée sur les méthodes de diagnostic, la répartition géographique et la population étudiée. Une méta-régression a été réalisée pour l’année de publication, la proportion de patients atteints de diarrhée et la proportion de patients avec CD4 < 200 cellules/mL. Cent soixante et une études et 51,123 participants séropositifs ont été inclus. La prévalence globale combinée de l’infection à Cryptosporidium chez les patients VIH-séropositifs était de 11,2 % (IC95 % : 9,4 %–13,0 %). La prévalence regroupée a été estimée à 10,0 % (IC95 % : 8,4 %–11,8 %) en utilisant des méthodes de coloration, 13,5 % (IC95 % : 8,9 %–19,8 %) en utilisant des méthodes moléculaires et 26,3 % (IC95 % : 15,0 %–42,0 %) en utilisant des méthodes de détection d’antigènes. La prévalence de Cryptosporidium chez les patients infectés par le VIH était significativement associée au pays d’étude. En outre, il existe des différences statistiques entre la diarrhée, les CD4 < 200 cellules/mL et les facteurs de risque du traitement antirétroviral avec la cryptosporidiose. Ainsi, Cryptosporidium est une infection courante chez les patients séropositifs, et une eau salubre et une hygiène des mains doivent être mises en œuvre pour prévenir la survenue de cryptosporidiose chez ces patients.

Keywords: AIDS; Cryptosporidium infection; HIV; Systematic review.

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Figures

Figure 1
Figure 1
Flowchart describing the study design.
Figure 2
Figure 2
Forest plot diagram: The estimated pooled prevalence of Cryptosporidium infection in people with HIV infection by random-effect meta-analysis in included studies based on the PCR technique (first author, year of publication, and country). Note: The area of each square is proportional to the study’s weight in the meta-analysis, and each line represents the confidence interval around the estimate. The diamond represents the pooled estimate.
Figure 3
Figure 3
Forest plot diagram: The estimated pooled prevalence of Cryptosporidium infection in people with HIV infection by random-effect meta-analysis in included studies based on serological methods (first author, year of publication, and country). Note: The area of each square is proportional to the study’s weight in the meta-analysis, and each line represents the confidence interval around the estimate. The diamond represents the pooled estimate.
Figure 4
Figure 4
Forest plot diagram: The estimated pooled prevalence of Cryptosporidium infection in people with HIV infection by random-effect meta-analysis in included studies based on the staining method (first author, year of publication, and country). Note: The area of each square is proportional to the study’s weight in the meta-analysis, and each line represents the confidence interval around the estimate. The diamond represents the pooled estimate.
Figure 5
Figure 5
Pooled prevalence of Cryptosporidium in HIV-positive patients in different countries (source of image: https://commons.wikimedia.org/wiki/File:BlankMap-World.svg).
Figure 6
Figure 6
Funnel plot of standard error by logit event rate to assess publication or other types of bias across prevalence studies.
See this image and copyright information in PMC

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