非洲成人艾滋病病毒感染者中隐球菌性脑膜炎的患病率及诱导治疗期间的死亡率预测因素：一项系统评价和荟萃分析
Prevalence of cryptococcal meningitis among people living with human immuno-deficiency virus and predictors of mortality in adults on induction therapy in Africa: A systematic review and meta-analysis.
作者信息
Muzazu Seke G Y, Assefa Dawit Getachew, Phiri Christabel, Getinet Tewodros, Solomon Samrawit, Yismaw Gizachew, Manyazewal Tsegahun
机构信息
Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
Enteric Diseases and Vaccines Research Unit, Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia.
出版信息
Front Med (Lausanne). 2022 Sep 8;9:989265. doi: 10.3389/fmed.2022.989265. eCollection 2022.
BACKGROUND
Cryptococcal meningitis (CM) is a leading cause of adult meningitis in countries with a high burden of HIV. It has remained a significant cause of morbidity and mortality in Africa despite the extensive rollout of HIV antiretroviral therapy (ART). This study aimed to systematically synthesize the evidence on the prevalence of CM among people living with HIV (PLWH) and its predictors of mortality among adults who are on induction antifungal therapy in Africa.
METHODS
PubMed/MEDLINE, Embase, and Google Scholar were searched for randomized clinical trials or observational studies published in Africa from 1995 to April 2021. Pooled prevalence of CM among PLWH was calculated using R-studio Version 1.4.1717 software and the data extracted from eligible studies were pooled as percentage with a 95% confidence interval (CI). Predictors of mortality among adults on induction antifungal therapy were synthesized narratively.
RESULTS
Out of 364 studies identified, 17 eligible articles were included in the analysis. The prevalence of CM among PLWH in Africa was 5.11% (95% CI 2.71-9.43%; participants = 10,813; studies = 9; = 97%). In the subgroup analysis, the prevalence was 12.9% (95% CI 4.883-30.0; participants = 533; studies = 3; = 63%) in the years 1995-2010 and 3.18% (95% CI 1.54-6.45; participants = 10,280; studies = 6; = 98%) in the years 2011-2021, with the prevalence significantly decreased by 51% ( = ). Predictors of mortality were fluconazole monotherapy, focal neurological signs, low Glasgow coma scale, and delayed diagnosis of CM at varied timepoint.
CONCLUSION
Prevalence of CM has significantly decreased from 1996-2010 to 2011-2021 among PLWH on induction therapy in Africa. Fluconazole monotherapy, focal neurological symptoms, diastolic blood pressure < 60 mmHg, and concurrent tuberculosis coinfection were significant predictors of mortality at 2- and 10-weeks timepoints. CM remains a major concern among PLWH despite increases in ART coverage. Improved access to effective antifungal therapies is needed in Africa for timely initiation of combination induction therapy and better treatment outcomes of PLWH.
SYSTEMATIC REVIEW REGISTRATION
[https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=254113], identifier [CRD42021254113].
背景
在艾滋病毒负担沉重的国家，隐球菌性脑膜炎（CM）是成人脑膜炎的主要病因。尽管广泛推行了艾滋病毒抗逆转录病毒疗法（ART），但在非洲，它仍然是发病和死亡的重要原因。本研究旨在系统地综合关于非洲艾滋病毒感染者（PLWH）中CM患病率及其在接受诱导抗真菌治疗的成年人中死亡率预测因素的证据。
方法
检索PubMed/MEDLINE、Embase和谷歌学术，查找1995年至2021年4月在非洲发表的随机临床试验或观察性研究。使用R-studio 1.4.1717版本软件计算PLWH中CM的合并患病率，并将从符合条件的研究中提取的数据合并为百分比及95%置信区间（CI）。对接受诱导抗真菌治疗的成年人死亡率的预测因素进行叙述性综合分析。
结果
在识别出的364项研究中，17篇符合条件的文章纳入分析。非洲PLWH中CM的患病率为5.11%（95%CI 2.71 - 9.43%；参与者 = 10813；研究 = 9；I² = 97%）。在亚组分析中，1995 - 2010年患病率为12.9%（95%CI 4.883 - 30.0；参与者 = 533；研究 = 3；I² = 63%），2011 - 2021年患病率为3.18%（95%CI 1.54 - 6.45；参与者 = 10280；研究 = 6；I² = 98%），患病率显著下降了51%（P = ）。死亡率的预测因素包括氟康唑单药治疗、局灶性神经体征、低格拉斯哥昏迷量表评分以及在不同时间点CM的延迟诊断。
结论
在非洲接受诱导治疗的PLWH中，CM患病率从1996 - 2010年到2011 - 2021年显著下降。氟康唑单药治疗、局灶性神经症状、舒张压<60 mmHg以及并发结核感染是2周和10周时间点死亡率的显著预测因素。尽管ART覆盖率有所提高，但CM仍然是PLWH中的一个主要问题。非洲需要改善获得有效抗真菌治疗的机会，以便及时开始联合诱导治疗并改善PLWH的治疗结果。
系统评价注册
[https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=254113]，标识符[CRD42021254113]
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