Prevalence and Risk Factors for Oropharyngeal, Esophageal, and Oral Candidiasis in HIV-Positive Individuals: A Systematic Review and Meta-Analysis

BACKGROUND: Oral, oropharyngeal, and esophageal candidiasis are common forms of mucosal candidiasis (MC) in people living with human immunodeficiency virus/acquired immunodeficiency syndrome (PLWHA). Despite differences in infection sites, oral, oropharyngeal, and esophageal candidiasis share common pathophysiological mechanisms, including etiologic agents, host susceptibility, and antibiotic use. Identifying prevalence and risk factors associated with these types of candidiasis in this population enables clinicians to manage these infections across the affected mucosal sites effectively. OBJECTIVE: To synthesize the global prevalence and identify the risk factors for oral, oropharyngeal, and esophageal candidiasis in PLWHA. METHODS: We searched PubMed, Embase, Scopus, and Cochrane and extracted the prevalence data and adjusted odds ratios (ORs) for each risk factor associated with MC. We calculated pooled ORs for risk factors present in a minimum of two studies. RESULTS: Fifteen studies were included. The overall prevalence of MC in PLWHA was 39.0% (95% CI: 27%-52%; I (2) ƒ_%=ƒ_%99.74%, p = 0.001). However, male gender (pooled OR 1.53, 95% CI 1.12-2.09, p = 0.007), CD4 cell count below 200ƒ_%cells/AæL (pooled OR 2.41; 95% CI 1.36-4.29; p = 0.003), and lack of highly active antiretroviral therapy (HAART) treatment (pooled OR 1.76; 95% CI 1.16-2.66; p = 0.008) are significant risk factors for MC development in the PLWHA. CONCLUSIONS: The global overall prevalence of MC in PLHWA was 39%. Risk factors, including male gender, CD4 count, and HAART, are shown to have significant effects on the development of MC in PLWHA. The results highlighted the significance of promptly recognizing and addressing these risk factors to reduce the incidence of MC in PLWHA

• Epidemiology and Determinants of Health
  • Epidemiology
• Population(s)
  • General HIV+ population
• Prevention, Engagement and Care Cascade
  • Engagement and Care Cascade
• Engagement and Care Cascade
  • Treatment
• Co-infections
  • Other
• Health Systems
  • Governance arrangements