Abstract
BackgroundSeroprevalence data and clinical studies in children suggest that the burden of pneumocystis pneumonia (PCP) in Africa may be underestimated. We performed a systematic review to determine the prevalence and attributable mortality of PCP amongst HIV-infected adults in sub-Saharan Africa.MethodsWe searched Pubmed, Web of Science, Africa-Wide: NiPAD and CINAHL, from Jan 1 1995 to June 1 2015, for studies that reported the prevalence, mortality or case fatality of PCP in HIV-infected adults living in sub-Saharan African countries. Prevalence data from individual studies were combined by random-effects meta-analysis according to the Mantel-Haenszel method. Data were stratified by clinical setting, diagnostic method, and study year.ResultsWe included 48 unique study populations comprising 6884 individuals from 18 countries in sub-Saharan Africa. The pooled prevalence of PCP among 6018 patients from all clinical settings was 15 · 4 % (95 % CI 12 · 9–18 · 0), and was highest amongst inpatients, 22 · 4 % (95 % CI 17 · 2–27 · 7). More cases were identified by bronchoalveolar lavage, 21 · 0 % (15 · 0–27 · 0), compared with expectorated, 7 · 7 % (4 · 4–11 · 1), or induced sputum, 11 · 7 % (4 · 9–18 · 4). Polymerase chain reaction (PCR) was used in 14 studies (n = 1686). There was a trend of decreasing PCP prevalence amongst inpatients over time, from 28 % (21–34) in the 1990s to 9 % (8–10) after 2005. The case fatality rate was 18 · 8 % (11 · 0–26 · 5), and PCP accounted for 6 · 5 % (3 · 7–9 · 3) of study deaths.ConclusionsPCP is an important opportunistic infection amongst HIV-infected adults in sub-Saharan Africa, particularly amongst patients admitted to hospital. Although prevalence appears to be decreasing, improved access to antiretroviral therapy and non-invasive diagnostics, such as PCR, are needed.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-016-1809-3) contains supplementary material, which is available to authorized users.
Highlights
Seroprevalence data and clinical studies in children suggest that the burden of pneumocystis pneumonia (PCP) in Africa may be underestimated
The year 1995 was chosen as a cut-off because previous reviews have reported on PCP prevalence from early studies in sub-Saharan Africa, and we wanted to assess the impact of more widespread availability of cotrimoxazole prophylaxis and antiretroviral therapy (ART)
We have performed a systematic review of PCP prevalence using diagnostic criteria with high specificity, a well-defined population denominator and clinically relevant categorisation of cases
Summary
Seroprevalence data and clinical studies in children suggest that the burden of pneumocystis pneumonia (PCP) in Africa may be underestimated. We performed a systematic review to determine the prevalence and attributable mortality of PCP amongst HIV-infected adults in sub-Saharan Africa. Pneumocystis jirovecii is a ubiquitous opportunistic fungal pathogen that causes pneumocystis pneumonia (PCP) in patients with cellular immune defects. Studies from African countries with high HIV prevalence reported PCP to be an uncommon OI [7,8,9]. An overwhelmingly high burden of other opportunistic diseases, early exposure to P. jirovecii resulting in improved immunity, and immune modulation by other infections are putative explanations for the reduced prevalence of PCP in sub-Saharan Africa [10,11,12]. A single recent study demonstrated an inverse relationship of PCP prevalence to gross domestic product [13].
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
