Prevalence and resistance patterns of Mycoplasma genitalium infection in people with HIV: A systematic review and meta-analysis

Objectives: This study aimed to estimate the prevalence of M. genitalium infection and understand the patterns of resistance associated mutations (resistance hereafter) in people with HIV (PWH).

Methods: We searched PubMed-MEDLINE, Embase and Web of Science to identify studies published as of December 31, 2023, reporting the prevalence of M. genitalium infection in PWH. The pooled prevalence of M. genitalium infection and its resistance was calculated using random-effect models.

Results: Totally 66 studies involving 22 763 PWH were included, with five studies reporting resistance. The overall pooled prevalence of M. genitalium infection in PWH was 12% [95% confidence interval (CI): 9–14], which differed across geographic regions ( P < 0.01), with the highest observed in North America (20%, 95% CI: 10–32). The pooled prevalence was the highest in female sex workers (FSW) living with HIV (20%, 95% CI: 10–32), but without statistical difference between different population groups ( P = 0.76). The pooled prevalence of macrolide resistance-mediating mutations (MRMMs), quinolone resistance-determining regions (QRDRs) mutations, and multidrug resistance with MRMMs and QRDRs mutations in PWH was 36% (95% CI: 5–77), 25% (95% CI: 8–47), and 20% (95% CI: 12–29), respectively.

Conclusion: The prevalence of M. genitalium infection in PWH in this study was lower than HIV preexposure prophylaxis users and FSW, but higher than men who have sex with men in the community. There’s substantial geographic variation in the prevalence of M. genitalium infection in PWH. The variability reflects differences in exposure risks as well as the testing/treatment strategies in place for sexually transmitted infections.

• Epidemiology and Determinants of Health
  • Epidemiology
• Population(s)
  • General HIV+ population
• Co-infections
  • Other