Prevalence of ocular toxoplasmosis among people living with HIV: a systematic review and meta-analysis

Abstract

Aim: To determine the prevalence of ocular toxoplasmosis among people living with HIV through a systematic review and meta-analysis. Materials & methods: A literature search was conducted, estimating pooled prevalence and performing quality assessment, outlier, influential and meta-regression analyses. Results: Twenty-nine studies were included in the analysis, revealing that the rate of ocular toxoplasmosis among people living with HIV was 0.37% (95% CI: 0.2–0.6). Substantial heterogeneity was observed among the studies. Despite analyzing continuous variables, including year of publication, proportion of males, mean age and proportion of patients receiving antiretroviral therapy, no statistically significant associations were found. Conclusion: This study provides an overview of the prevalence of ocular toxoplasmosis in people living with HIV, emphasizing the need for further research to uncover factors contributing to its development.

Plain language summary

This study looked at how common ocular toxoplasmosis, a type of parasitic infection, is among people living with HIV. We did this by reviewing other studies, combining their results and evaluating the quality of each study. We also looked for any unusual findings and other factors that might affect the prevalence of ocular toxoplasmosis. After analyzing 29 studies, we found that approximately 0.37% of people living with HIV had ocular toxoplasmosis, ranging from 0.2% to 0.6%. There was a significant variation in the results among the studies. Our study provides an overview of the prevalence of ocular toxoplasmosis in people living with HIV, highlighting the need for further research to identify the factors contributing to its development.

Summary points

Global significance of ocular toxoplasmosis

• Ocular toxoplasmosis, caused by Toxoplasma gondii, is a major contributor to vision impairment and ocular morbidity worldwide.

Challenges in diagnosis

• Diagnosing ocular toxoplasmosis can be challenging, relying on clinical symptoms, funduscopic examinations and, if needed, additional serological tests measuring IgM and IgG antibodies or PCR tests on ocular fluids.

HIV/AIDS complications

• Individuals with HIV/AIDS face a heightened risk of ocular toxoplasmosis due to compromised immune systems, leading to increased incidence and severity of ocular complications.

Prevalence findings

• The estimated prevalence of ocular toxoplasmosis among people living with HIV was calculated at 0.37% (95% CI: 0.2–0.6).

Heterogeneity considerations

• The analysis revealed substantial heterogeneity among the included studies, indicating substantial variability in prevalence estimates. Several factors may contribute to this heterogeneity, emphasizing the need for cautious interpretation of results and highlighting the inherent challenges in studying infectious diseases with evolving prevalence patterns over time.

Meta-regression analysis

• The meta-regression analysis did not identify statistically significant associations between prevalence and continuous variables such as publication year, proportion of males, mean age and proportion of individuals receiving antiretroviral therapy.

Clinical implications & future research

• The study underscores the need for increased awareness, early detection and management strategies for ocular toxoplasmosis in individuals with HIV.

Limitations

• Limitations, such as temporal considerations and reporting bias, emphasize the importance of ongoing research for a more comprehensive understanding and effective management of this co-infection.

Keywords: :

• AIDS
• HIV
• meta-analysis
• ocular toxoplasmosis
• retinochoroiditis
• Toxoplasma gondii

Author contributions

Study conception and design, manuscript writing, critical revision of the manuscript, professional opinion and supervision: M Kantzanou. Literature search, data analysis, quality assessment, statistical meta-analysis, interpretation of results and manuscript writing: E Kostares. Literature search, data analysis, interpretation of results, manuscript editing, quality assessment and professional opinion: G Kostare. Literature search, data analysis, interpretation of results, manuscript writing and professional opinion: F Boufidou. Literature search, data analysis and manuscript editing: A Tzanai. Literature search, data analysis, interpretation of results, manuscript writing and professional opinion: M Kostares. Critical revision of the manuscript, professional opinion and supervision: A Tsakris. All authors read and approved the final manuscript.

Financial disclosure

The authors have no financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending or royalties.

Competing interests disclosure

The authors have no competing interests or relevant affiliations with any organization or entity with an interest in or conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending or royalties.

Writing disclosure

No writing assistance was utilized in the production of this manuscript.