Pneumocystis jirovecii pneumonia in tropical and low and middle income countries: a systematic review and meta-regression

Pneumocystis jirovecii pneumonia (PCP), the commonest opportunistic infection in HIV-infected patients in the developed world, is less commonly described in tropical and low and middle income countries (LMIC). We sought to investigate predictors of PCP in these settings. Systematic review and meta-r...

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Bibliographic Details
Published in:PloS one 2013-08, Vol.8 (8), p.e69969-e69969
Main Authors: Lowe, David M, Rangaka, Molebogeng X, Gordon, Fabiana, James, Chris D, Miller, Robert F
Format: Article
Language:English
Subjects:
Acquired immune deficiency syndrome
AIDS
Antiretroviral agents
Antiviral agents
Bias
Biology
CD4 antigen
Children
Developing Countries - economics
Diagnosis
Diagnostic systems
Disease transmission
Epidemiology
Health aspects
Health risks
HIV
Human immunodeficiency virus
Humans
Income
Medical research
Medicine
Meta-Analysis as Topic
Opportunist infection
Patients
Pneumocystis carinii - physiology
Pneumonia
Pneumonia, Pneumocystis - diagnosis
Pneumonia, Pneumocystis - economics
Pneumonia, Pneumocystis - microbiology
Pneumonia, Pneumocystis - prevention & control
Population studies
Poverty
Prophylaxis
Regression
Risk
Risk reduction
Sensitivity analysis
Signs and symptoms
Virulence (Microbiology)
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Summary:Pneumocystis jirovecii pneumonia (PCP), the commonest opportunistic infection in HIV-infected patients in the developed world, is less commonly described in tropical and low and middle income countries (LMIC). We sought to investigate predictors of PCP in these settings. Systematic review and meta-regression. Meta-regression of predictors of PCP diagnosis (33 studies). Qualitative and quantitative assessment of recorded CD4 counts, receipt of prophylaxis and antiretrovirals, sensitivity and specificity of clinical signs and symptoms for PCP, co-infection with other pathogens, and case fatality (117 studies). The most significant predictor of PCP was per capita Gross Domestic Product, which showed strong linear association with odds of PCP diagnosis (p30%; treatment was largely appropriate. Prophylaxis appeared to reduce the risk for development of PCP, however 24% of children with PCP were receiving prophylaxis. CD4 counts at presentation with PCP were usually
ISSN:1932-6203
1932-6203
DOI:10.1371/journal.pone.0069969