Seroprevalence Estimates of Latent and Acute Toxoplasma Infections in HIV+ People—Call for Action in Underprivileged Communities

Abstract

We undertook a comprehensive, systematic review of observational studies to estimate respective seroprevalences of latent and acute Toxoplasma gondii infections in HIV⁺ people at the global, regional and country levels; related seroprevalence to socio-economic variables and CD4+ cell counts; and assessed temporal changes in prevalence and risk factors for this group. We systematically searched international databases for seroepidemiological surveys between 1 January 1980 and 31 July 2020. We used a random effects model to calculate pooled seroprevalences with 95% confidence intervals (CI), and estimated the numbers of HIV⁺ people inferred to harbour latent and acute T. gondii infections (LT or AT). We grouped seroprevalence data according to the geographic regions defined by the World Health Organization (WHO) and conducted subgroup and meta-regression analyses of the data. Of a total of 4024 studies identified, 150 and 65 of them met the inclusion criteria for LT and AT in HIV⁺ people, respectively. The overall, pooled seroprevalences of LT and AT were 37.4% (95% CI, 33.4–41.4) and 1.3% (95% CI, 0.9–1.8%), equating to ~14.2 and 0.5 million HIV⁺ people, respectively. Most HIV⁺ people with T. gondii infections originated from Africa, and the highest seroprevalences were in low-income countries with low human development indices. Significant risk factors for toxoplasmosis in HIV⁺ patients included the consumption of raw/undercooked meat, frequent contact with soil, a low CD4+ T lymphocyte number (T. gondii infection in HIV⁺ people in underprivileged regions of the world, such as parts of Africa, calls for preventative action. Programs that include routine serological monitoring, counselling, care, animal control and/or prophylactic treatment measures are needed to prevent severe toxoplasmosis from developing in people living with HIV infection. Our study highlights the potential importance of parasite chemoprophylaxis in resource-poor settings, particularly in low-income countries.