Global status ofToxoplasma gondiiinfection and associated risk factors in people living with HIV

Objective: Toxoplasmainfection remains as the most common cause of focal brain lesions among people living with HIV (PLHIV) despite the decline in opportunistic infections with the introduction of antiretroviral treatment. This study was conducted to provide a summary of evidence about the seroprevalence ofToxoplasma gondiiand prevalence of activeT. gondiiinfection and associated risk factors among PLHIV. Design: Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. Scopus, PubMed, Science Direct and EMBASE were searched from1997 to July 2018.All peer-reviewed original research articles describingT. gondiiinfection among PLHIV with different diagnostic methods were included. Methods: Incoherence and heterogeneity between studies were quantified byI(2)index and Cochran'sQtest. Publication and population bias were assessed with funnel plots and Egger's regression asymmetry test. All statistical analyses were performed using StatsDirect. Results: In total, 111 studies from 37 countries assessing 66 139 blood samples were included in this study. The pooled prevalence ofT. gondiiinfection among PLHIV was 3.24% by IgM and 26.22% by molecular methods using the random-effects model. Pooled seroprevalence ofT. gondiiby IgG was 44.22%. There was a relationship betweenToxoplasmaprevalence and sex, raw meat consumption, contact with cat and knowledge about toxoplasmosis. Conclusion: HighToxoplasmaseroprevalence among PLHIV observed in this study emphasizes the need for implementing screening and prophylaxis tailored to the local context. Owing to the serious and significant clinical manifestations of the parasite in case of reactivation, early identification of seropositivity for initiating prophylaxis among those with a CD4(+)cell count of less than 200 cells/ml is recommended.