Prevalence estimates of human immunodeficiency virus (HIV) infection among visceral leishmaniasis infected people in Northwest Ethiopia: a systematic review and meta-analysis

Abstract

Background: In Ethiopia, by the end of 2018, an estimated 690,000 people are infected with HIV and the annual cases of Visceral Leishmaniasis (VL) is estimated to be between 4000 and 5000 with over 3.2 million people are at risk. Northwest Ethiopia accounts for over 60% cases of VL in the country. Prevalence of HIV infection among VL infected people in Ethiopia has not yet been synthesized. Therefore, we aimed to estimate the pooled prevalence of HIV infection among VL infected people in Northwest Ethiopia with the hope that it would guide the development of a more robust and cost-effective intervention strategies. Methods: In this systematic review and meta-analysis, we searched six international databases: PubMed, Ovid MEDLINE®, Embase, Scopus, Google Scholar, and ProQuest Dissertations & Theses. We also searched reference lists of included studies and Ethiopian universities electronic thesis and dissertation repositories. The search was performed until June 30, 2019. Funnel plot symmetry visualization confirmed by Egger's regression asymmetry test and Begg rank correlation methods was used to assess publication bias. Pooled prevalence estimate was calculated using Der Simonian and Laird's random Effects model. We went further to perform univariate meta-regression and subgroup analysis to identify a possible sources of heterogeneity among the studies. STATA software (version 14, Texas, USA) was used for analysis. Results: From 1286 citations identified by our search, 19 relevant studies with 5355 VL infected individuals were included in this meta-analysis. The pooled prevalence of HIV infection among VL infected individuals in Northwest Ethiopia was 24% (95%CI: 17-30%). The result of sensitivity analysis demonstrated that the pooled prevalence estimate was robust and not one-study dependent. The pooled prevalence estimate of HIV infection among VL infected people in Northwest Ethiopia ranged from 20.88% (95%CI: 15.91-25.86) to 24.86% (95%CI: 18.57-31.14) after a single study was deleted. Conclusions: The burden of HIV infection in people infected with VL in Northwest Ethiopia is considerably high. Integrating HIV/AIDS surveillance among VL infected people would improve case detection as well as prevention and control of disease spread.

Diagnostic accuracy of direct agglutination test, rK39 ELISA and six rapid diagnostic tests among visceral leishmaniasis patients with and without HIV coinfection in Ethiopia

“…In northwest Ethiopia, up to 24.% of VL cases are HIV co-infected [ 12 ] and this is likely an underestimation as only 17% of VL cases are screened for HIV [ 38 ]. Current guidelines recommend HIV screening in VL cases [ 36 ].…”

“…Prevalence of coinfection in Northwest Ethiopia varies greatly over different studies. A recent meta-analysis estimated the VL-HIV coinfection prevalence to range from 20.88% to 24.86% [ 12 ]. Few studies have assessed the performance of serological assays in the VL-HIV coinfected population in East Africa, but current data suggests a lower sensitivity in VL-HIV coinfected patients [ 13 ].…”

Utility of the Loop-Mediated Isothermal Amplification Assay for the Diagnosis of Visceral Leishmaniasis from Blood Samples in Ethiopia

“…[4][5][6][7] HIV-Leishmania coinfection in Ethiopia is one of the highest (20-40%) in the world, [8][9][10][11] though recent data suggest a trend towards reduction around 20%. 12 Untreated VL can cause severe morbidity and ultimately leading to death in almost all cases. Accurate and prompt diagnosis of VL is thus essential to initiate treatment immediately as is monitoring of treatment efficacy to prevent morbidity and mortality.…”

Diversity and within-host evolution of parasites from VL and VL/HIV patients in Northern Ethiopia

“…One factor in the growth of VL in Ethiopia is co-infection, and particularly co-infection of L. donovani with HIV. While VL/HIV coinfection is a widespread concern (Lindoso et al 2018), Ethiopia has the highest rate of VL/HIV co-infections in Africa -and possibly globally -and while estimates vary between studies, HIV may be present in over 20% of VL cases (Leta et al 2014;Mohebali and Yimam 2020). In Ethiopia and elsewhere, HIV coinfection is known to increase the probability that L. donovani infections progress to symptomatic visceral leishmaniasis (Hurissa et al 2010;Albuquerque et al 2014).…”