Distribution of Candida species causing Oropharyngeal Candidiasis among People Living with HIV in Africa: A systematic review and Meta-analysis
- Gerald Mboowa, Department of Medical Laboratory Sciences, Muni University, Arua, Uganda 2Department of Medical Pathology, Soroti University, Soroti, Uganda
- Benson Musinguzi, Department of Medical Laboratory Sciences, Muni University, Arua, Uganda
- Obondo James, Department of Medical Laboratory Sciences, Muni University, Arua, Uganda 2Department of Medical Pathology, Soroti University, Soroti, Uganda
Presented at 21st Annual HuQAS Scientific Conference
Background
The incidence of Oropharyngeal candidiasis (OPC) among People living with HIV(PLWH) in Africa is on the raise and so are its etiological Candida species. Oropharyngeal candidiasis is mainly caused by C. albicans, however, a shift in the etiology towards non- Candida albicans (NAC) species is on the increase and there are variations in the epidemiological distribution of Candida species causing OPC among PLWH.
Objective
We aimed to determine the distribution of Candida species causing OPC among People Living with HIV in Africa.
Materials and Methods
Our protocol was registered by PROSPERO prior to its conduct (CRD42021254473). We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for our review. We searched databases for relevant English- published articles from PubMed, MEDLINE Ovid, Scopus and Google Scholar that were published between January 2000 and February 2022.
Results
Fourteen (14) studies including 3863 participants were included in the meta-analysis and the pooled prevalence of OPC was 49.0% with a 95% CI of 37 to 62%. A total of 2688 Candida isolates were reported to be causing OPC among PLWH in Africa. About 76.6% (n=2060) were Candida albicans and 21.7% (n=582) were non- Candida albicans. Of the non- Candida albicans species, C. glabrata was the most frequent isolate (29.6%), followed by C. tropicalis (27.7%) and C. krusei (17.0%). Generally, the prevalence of NAC and OPC has increased over the two decades while that of C. albicans has sluggishly decreased. Cumulative prevalence ranged from 45% in 2011 to 92% in 2017 for C. albicans, from 8% in 2002 to 55% in 2011 for NAC while OPC ranged from 32% in 2014 to 69% in 2016.
Conclusion
Gradual increase in non- Candida albicans and unidentifiable species causing OPC has been noted. Use of accurate molecular diagnostic approaches to speciate Candida species and their antifungal susceptibility profile to decrease morbidity associated with OPC warrants further research.