A global overview of microsporidia infection in HIV/AIDS patients: an updated systematic review and meta-analysis
Abstract
Background: This study aimed to update the global estimates of microsporidia prevalence, species/genotype distribution and clinical correlates among human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) patients.
Methods: A systematic search of international databases was conducted for studies published between 1 January 2017 and 11 October 2025. Pooled prevalence and odds ratios (ORs) were calculated using a random effects model with 95% confidence intervals (CIs).
Results: Thirty-nine studies from 18 countries (24 cross-sectional, 15 case-control) were included. The pooled prevalence of microsporidia among HIV/AIDS patients was 12% (95% CI 8.9 to 16), significantly higher than in controls (1.9%; odds ratio 5.7 [95% CI 3.33 to 9.74]). A higher pooled prevalence of microsporidia infection was observed in studies published after 2020 (15.9%), in those with sample sizes ≤100 participants (19.2%), in patients with CD4 counts ≤200 cells/μl (58.4%) and in males (64.9%). The highest country-specific prevalence rates were reported from Malaysia (60.9%), Mexico (48.3%), Malawi (37.0%) and South Africa (32.9%). Enterocytozoon bieneusi was the predominant species, accounting for 24 identified genotypes, followed by Encephalitozoon intestinalis, E. cuniculi and E. hellem.
Conclusions: Microsporidia remain a significant opportunistic pathogen in HIV/AIDS patients. Strengthened molecular surveillance, standardized diagnostic protocols and integration of…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 100 participants or records.
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