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Review
. 2023 Feb 13;8(2):114.
doi: 10.3390/tropicalmed8020114.

The Burden of Pneumocystis Pneumonia Infection among HIV Patients in Ethiopia: A Systematic Review

Yared Mulu Gelaw  1   2 , Yonas Deressa Guracho  1   3 , Florence Robert-Gangneux  2 , Getu Degu Alene  1 , Jean-Pierre Gangneux  2
Affiliations
Review

The Burden of Pneumocystis Pneumonia Infection among HIV Patients in Ethiopia: A Systematic Review

Yared Mulu Gelaw et al. Trop Med Infect Dis. .

Abstract

Pneumocystis pneumonia (PCP) is a leading cause of death among patients with AIDS worldwide, but its burden is difficult to estimate in low- and middle-income countries, including Ethiopia. This systematic review aimed to estimate the pooled prevalence of PCP in Ethiopia, the second most densely populated African country. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines were used to review published and unpublished studies conducted in Ethiopia. Studies that reported on the prevalence of PCP among HIV-infected patients were searched systematically. Variations between the studies were assessed by using forest plot and I-squared heterogeneity tests. Subgroup and sensitivity analyses were carried out when I2 > 50. The pooled estimate prevalence with 95% CI was computed using a random-effects model of analysis. Thirteen articles, comprising studies of 4847 individuals living with HIV, were included for analysis. The pooled prevalence of PCP was 5.65% (95% CI [3.74-7.56]) with high heterogeneity (I2 = 93.6%, p < 0.01). To identify the source of heterogeneity, subgroup analyses were conducted by study design, geographical region, diagnosis methods, and year of publication. PCP prevalence differed significantly when biological diagnostic methods were used (32.25%), in studies published before 2010 (32.51%), in cross-sectional studies (8.08%), and in Addis Ababa (14.05%). PCP prevalence differences of 3.25%, 3.07%, 3.23%, and 2.29% were recorded in studies based on clinical records, published since 2017, follow-up studies, and north-west Ethiopian studies, respectively. The prevalence of PCP is probably underestimated, as the reports were mainly based on clinical records. An expansion of biological diagnostic methods could make it possible to estimate the exact burden of PCP in Ethiopia.

Keywords: Africa; Ethiopia; HIV; Pneumocystis jirovecii; Pneumocystis pneumonia; burden; fungal diseases; systematic review.

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Conflict of interest statement

The authors declared no conflicts of interest.

Figures

Figure 1
Figure 1
PRISMA flow diagram of identification and selection of studies for the systematic review and meta-analysis. PCP: Pneumocystis pneumonia. OIs: opportunistic infections.
Figure 2
Figure 2
Forest plot of the proportion of PCP among HIV patients in Ethiopia (2003–2020, I2 = 93.6%, p < 0.01); Q statistics (242.2185, p < 0.0001); and test of overall effect (0, z = 5.797, p = 0.000). High heterogeneity is suggested in the effect size. To identify the source of heterogeneity, the authors conducted a subgroup analysis [18,21,26,27,28,29,30,31,32,33,34,35,36].
Figure 3
Figure 3
Subgroup analysis by study design [18,21,26,27,28,29,30,31,32,33,34,35,36].
Figure 4
Figure 4
Subgroup analysis by year of publication [18,21,26,27,28,29,30,31,32,33,34,35,36].
Figure 5
Figure 5
Subgroup analysis by geographical regions where the study was carried out [18,21,26,27,28,29,30,31,32,33,34,35,36].
Figure 6
Figure 6
Subgroup analysis by methods of diagnosis [18,21,26,27,28,29,30,31,32,33,34,35,36].
Figure 7
Figure 7
Funnel plot: visual inspection of publication bias for meta-analysis of Pneumocystis pneumonia.
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