Global status of Toxoplasma gondii infection and associated risk factors in people living with HIV: a systematic review and meta-analysis

Hanie Safarpour, Muge Cevik, Mehdi Zarean, Aleksandra Barac, Kareem Hatam-Nahavandi, Mohammad Taghi Rahimi, Hossein Bannazadeh Baghi, Tohid Jafari Koshki, Abdol Sattar Pagheh, Firooz Shahrivar, Mina Ebrahimi, Ehsan Ahmadpour

Research output: Contribution to journalArticlepeer-review

10 Citations (Scopus)
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OBJECTIVE: Toxoplasma infection remains as the most common cause of focal brain lesions among people living with HIV (PLHIV) despite the decline in opportunistic infections with the introduction of antiretroviral treatment. This study was conducted to provide a summary of evidence about the seroprevalence of Toxoplasma gondii and prevalence of active T. gondii infection and associated risk factors among PLHIV.

DESIGN: PRISMA guidelines were followed. Scopus, PubMed, Science Direct, and EMBASE were searched from 1997 to July 2018. All peer-reviewed original research articles describing T. gondii infection among PLHIV with different diagnostic methods were included.

METHODS: Incoherence and heterogeneity between studies were quantified by I2 index and Cochran's Q test. Publication and population bias were assessed with funnel plots and Egger's regression asymmetry test. All statistical analyses were performed using StatsDirect.

RESULTS: A total of 111 studies from 37 countries assessing 66,139 blood samples were included in this study. The pooled prevalence of T. gondii infection among PLHIV was 3.24% by IgM and 26.22% by molecular methods using the random-effects model. Pooled seroprevalence of T. gondii by IgG was 44.22%. There was a relationship between Toxoplasma prevalence and gender, raw meat consumption, contact with cat and knowledge about toxoplasmosis.

CONCLUSION: High Toxoplasma seroprevalence among PLHIV observed in this study emphasizes the need for implementing screening and prophylaxis tailored to the local context. Owing to the serious and significant clinical manifestations of the parasite in case of reactivation, early identification of seropositivity for initiating prophylaxis among those with a CD4 count of <200cells/mL is recommended.

Original languageEnglish
Pages (from-to)469-474
Issue number3
Early online date9 Nov 2019
Publication statusPublished - 1 Mar 2020


  • AIDS
  • HIV
  • Immunocompromised
  • Prevalence
  • Toxoplasma gondii
  • Toxoplasmosis


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