Worldwide Epidemiology of Cyclospora cayetanensis in HIV/AIDS Patients: A Systematic Review and Meta-Analysis.

BACKGROUND

Cyclospora cayetanensis is a coccidian protozoan parasite belonging to the phylum Apicomplexa. This systematic review and meta-analysis aimed to assess the prevalence and risk factors of C. cayetanensis in patients with Human Immunodeficiency Virus (HIV)/ Acquired Immunodeficiency Syndrome (AIDS).

METHODS

A literature search was performed in international databases for studies published until October 18, 2024, focusing on cross-sectional and case-control studies. Data from eligible studies were analyzed using Comprehensive Meta-Analysis (CMA) software, employing random-effects models for pooled estimates and weighted odds ratios (ORs), along with heterogeneity assessment via I² statistic.

RESULTS

This systematic review analyzed 73 studies, including 48 cross-sectional and 25 case-control involving 13,986 HIV/AIDS patients and 3,559 non-HIV/AIDS controls across 22 countries, mainly in Asia and Africa. The global prevalence of C. cayetanensis infection was 4% in HIV/AIDS patients (95% CI: 2.9-5.4%) versus 1.8% in controls (95% CI: 1.1-3.2%), resulting in an OR of 3.5 (95% CI: 2.04-6.06), indicating HIV/AIDS patients were significantly more likely to be infected. Sensitivity analysis indicated that none of the studies significantly affected the pooled estimates and weighted ORs. The prevalence of infection showed no significant association with quantitative variables such as publication year, sample size, and Human Development Index (HDI). Moreover, the pooled prevalence of C. cayetanensis infection was estimated across various subgroups, including publication year, World Health Organization (WHO) region, country, continent, country income level, HDI value, and sample size.

CONCLUSION

The findings confirm the opportunistic nature of C. cayetanensis infection and highlight the need for increased awareness and diagnosis of this infection in HIV/AIDS patients. Monitoring this opportunistic infection is vital for patient management, particularly in resource-limited areas.