Burden of Talaromyces marneffei infection in people living with HIV/AIDS in Asia during ART era: a systematic review and meta-analysis
Abstract Background: Talaromyces marneffei (TM) is a dimorphic fungus mainly prevalent in Southeast Asian countries, which often causes disseminated life-threatening infection. TM infection often occurs in HIV/AIDS patients even in the antiretroviral therapy (ART) era. However, there has not been a systematic analysis of the prevalence of TM infection in HIV-infected populations in Asia.Methods:In this study, we searched Pubmed, Embase, Web of Science, CNKI, and WanFang from inception to 21 November 2018 for studies reporting TM infection in people living with HIV/AIDS (PLWHA). Our meta-analysis included studies investigating the prevalence of TM infection in PLWHA. Reviews, duplicate studies, and animal studies were excluded. Random effects model was used to estimate the pooled prevalence and meta-regression analysis was conducted to explore potential factors for heterogeneity.Results: 159,064 patients with HIV infection in 33 eligible studies were included in our meta-analysis. The pooled prevalence of TM infection in PLWHA was 4.0%. Vietnam had the highest prevalence (6.4%), followed by Thailand (3.9%), China (3.3%), India (3.2%) and Malaysia (2.1%). In China, TM infection was most prevalent in South China (15.0%), while the burden in Southwest China was not very heavy (0.3%). TM infection in PLWHA in lower latitude area was significantly more prevalent than that in higher latitude area (OR 2.838, 95%CI: 2.376-3.390, P<0.001). CD4 counts below 200 cells/mm3 increased the risk of TM infection in PLWHA (OR 12.68, 95%CI: 9.58-16.77). However, accessing ART did not significantly decrease the risk of TM infection in PLWHA. Conclusions: The burden of TM infection is heavy in Asia and varies from region to region. PLWHA in lower latitude areas are more likely to suffer from TM infection. Optimization of diagnostic tools and universal screening of TM in vulnerable people for early case detection and for prompt antifungal treatment should be considered.