Burden of pneumocystis pneumonia in HIV-infected adults in sub-Saharan Africa: a systematic review and meta-analysis

 

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dc.contributor.author Wasserman, Sean
dc.contributor.author Engel, Mark E
dc.contributor.author Griesel, Rulan
dc.contributor.author Mendelson, Marc
dc.date.accessioned 2016-10-19T13:40:46Z
dc.date.available 2016-10-19T13:40:46Z
dc.date.issued 2016-09-09
dc.identifier 10.1186/s12879-016-1809-3
dc.identifier.citation Wasserman, S. A., Engel, M., Griesel, R., & Mendelson, M. (2016). Burden of pneumocystis pneumonia in HIV-infected adults in sub-Saharan Africa: A systematic review and meta-analysis. International Journal of Infectious Diseases, 45, 318-319.
dc.identifier.issn 1471-2334
dc.identifier.uri http://dx.doi.org/10.1186/s12879-016-1809-3
dc.identifier.uri http://hdl.handle.net/11427/22212
dc.description.abstract Abstract Background 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. Methods We 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. Results We 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. Conclusions PCP 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.
dc.publisher BioMed Central
dc.source BMC Infectious Diseases
dc.source.uri https://bmcinfectdis.biomedcentral.com/
dc.title Burden of pneumocystis pneumonia in HIV-infected adults in sub-Saharan Africa: a systematic review and meta-analysis
dc.type Journal Article
dc.type Journal Article
dc.type Journal Article en_ZA
dc.date.updated 2016-09-09T18:03:10Z
dc.language.rfc3066 en
dc.rights.holder The Author(s).
uct.type.publication Research en_ZA
uct.type.resource Article en_ZA
dc.publisher.institution University of Cape Town
dc.publisher.faculty Faculty of Health Sciences en_ZA
dc.publisher.department Division of Infectious Disease and HIV Med en_ZA
uct.type.filetype Text
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