Prevalence of HIV-associated esophageal candidiasis in sub-Saharan Africa: a systematic review and meta-analysis

Abstract

Background Esophageal candidiasis (OC) is a common AIDS-defining opportunistic infection. Antiretroviral therapy (ART) reduces the occurrence of OC and other opportunistic infections among persons living with HIV (PLHIV). We sought to determine and compare the prevalence of OC in the ART and pre-ART era among PLHIV in sub-Saharan Africa (SSA). Methods We searched PubMed, Embase, Web of Science, and the African Journals Online databases to select studies in English and French reporting the prevalence of HIV-associated OC in SSA from January 1980 to June 2020. Reviews, single-case reports, and case series reporting < 10 patients were excluded. A random-effect cumulative meta-analysis was performed using STATA 16.0, and trend analysis performed using GraphPad Prism 8.0. Results Thirteen eligible studies from 9 SSA countries including a total of 113,272 patients were qualitatively synthesized, and 9 studies were included in the meta-analysis. Overall pooled prevalence of HIV-associated OC was 12% (95% confidence interval (CI): 8 to 15%, I2 = 98.61%, p <. 001). The prevalence was higher in the pre-ART era compared to the ART era, but not to statistical significance (34.1% vs. 8.7%, p = 0.095). In those diagnosed by endoscopy, the prevalence was higher compared to patients diagnosed by non-endoscopic approaches, but not to statistical significance (35.1% vs. 8.4%, p = .071). The prevalence of OC significantly decreased over the study period (24 to 16%, p < .025). Conclusion The prevalence of OC among PLHIV in the ART era in SSA is decreasing. However, OC remains a common problem. Active endoscopic surveillance of symptomatic patients and further empirical studies into the microbiology, optimal antifungal treatment, and impact of OC on quality of life of PLHIV in SSA are recommended.

Prevalence of and Factors Associated with Reoccurrence of Opportunistic Infections Among Adult HIV/AIDS Patients Attending the ART Clinic at Public Health Facilities in Arba Minch Town, Southern Ethiopia

“…These OIs reduce the immunity and survival of PLHIV. [10][11][12][13][14][15][16] Different factors have been associated with the reoccurrence of OIs: older age, higher body mass index (BMI), incomplete treatment for OIs, not taking prescribed antiretroviral therapy (ART) appropriately, cell differentiation-4 (CD4) count <200 cells/mm 3 , and clinical stage of HIV/ AIDS are some of the factors that are significantly associated with the reoccurrence of OIs. 8,17 Ethiopia is one of the countries in sub-Saharan Africa with a high burden of OIs.…”

“…3 (10-13.9) and 12.9(11)(12)(13)(14) g/dL, respectively. All 450 patients were taking ART throughout the follow-up period.…”

Re-estimation of the burden of serious fungal diseases in Uganda

“…From sub-Saharan Africa, our meta-analysis of HIV-associated esophageal candidiasis found an overall pooled prevalence of 12% in nine studies detailing 113,272 affected. 72 The prevalence was relatively higher in the pre-ART era compared to the ART era (34.1% versus 8.7%). However, the pooled data are small compared to the millions of PLWH in Africa, so this estimate is uncertain.…”

Epidemiology of fungal diseases in Africa: A review of diagnostic drivers

“…Oesophageal candidiasis is an AIDS-defining illness seen in about 12% of patients with HIV/AIDS in sub-Saharan Africa [ 45 ]. Symptoms of oropharyngeal candidiasis include a burning sensation in the mouth, oral pain, dry mouth, throat pain, and impaired taste.…”