Wasserman Sean, Engel Mark E, Mendelson Marc
Division of Infectious Diseases and HIV Medicine, Cape Town, South Africa.
Syst Rev. 2013 Dec 12;2:112. doi: 10.1186/2046-4053-2-112.
Reports from Africa have suggested that pneumocystis pneumonia (PCP) is a less important cause of morbidity than in the developed world. However, more recent studies have shown high seroprevalence rates of P. jirovecii in healthy individuals with HIV as well as high rates of clinical disease in African children. This suggests that PCP may be more common in Africa than was previously recognised. Understanding the contribution of PCP to disease in HIV-infected individuals in sub-Saharan Africa (SSA) has important implications for diagnosis, management and resource allocation. We therefore propose to conduct a systematic review and meta-analysis in order to investigate the burden of PCP in this population.
We plan to search electronic databases and reference lists of relevant articles published from 1995 to May 2013 using broad terms for pneumocystis, HIV/AIDS and sub-Saharan Africa. Studies will be included if they provide clear diagnostic criteria for PCP and well-defined study populations or mortality data (denominator). A novel quality score assessment tool has been developed to ensure fidelity to inclusion criteria, minimise risk of selection bias between reviewers and to assess quality of outcome ascertainment. This will be applied to eligible full-text articles. We will extract data using a standardised form and perform descriptive and quantitative analysis to assess PCP prevalence, mortality and case fatality, as well as the quality of included studies. This review protocol has been published in the PROSPERO International Prospective Register of systematic reviews, registration number CRD42013005530.
Our planned review will contribute to the diagnosis and management of community-acquired pneumonia in HIV-infected individuals in SSA by systematically assessing the burden of PCP in this population. We also describe a novel quality assessment tool that may be applied to other prevalence reviews.
来自非洲的报告表明，与发达国家相比，肺孢子菌肺炎（PCP）作为发病原因的重要性较低。然而，最近的研究显示，在感染HIV的健康个体中，耶氏肺孢子菌的血清阳性率很高，并且在非洲儿童中临床疾病发生率也很高。这表明PCP在非洲可能比之前认为的更为常见。了解PCP对撒哈拉以南非洲（SSA）地区HIV感染者疾病的影响，对于诊断、管理和资源分配具有重要意义。因此，我们建议进行一项系统评价和荟萃分析，以调查该人群中PCP的负担。
我们计划检索电子数据库以及1995年至2013年5月发表的相关文章的参考文献列表，使用关于肺孢子菌、HIV/AIDS和撒哈拉以南非洲的宽泛术语。如果研究提供了PCP的明确诊断标准以及明确界定的研究人群或死亡率数据（分母），则将其纳入。已经开发了一种新颖的质量评分评估工具，以确保符合纳入标准，最大限度地减少评审者之间选择偏倚的风险，并评估结果确定的质量。这将应用于符合条件的全文文章。我们将使用标准化表格提取数据，并进行描述性和定量分析，以评估PCP的患病率、死亡率和病死率，以及纳入研究的质量。本综述方案已发表在国际前瞻性系统评价注册库PROSPERO中，注册号为CRD42013005530。
我们计划进行的综述将通过系统评估该人群中PCP的负担，为SSA地区HIV感染者社区获得性肺炎的诊断和管理做出贡献。我们还描述了一种新颖的质量评估工具，该工具可能适用于其他患病率综述。
