Neglected Risk Factors for HIV and Toxoplasma Gondii Co-Infection – Authors' Reply

We thank Jin Chen and colleagues and Amir Abdoli for their Correspondence about our study assessing Toxoplasma gondii and HIV co-infection worldwide.1Wang ZD Wang SC Liu HH et al.Prevalence and burden of Toxoplasma gondii infection in HIV-infected people: a systematic review and meta-analysis.Lancet HIV. 2017; 4: e177-e188Summary Full Text Full Text PDF PubMed Scopus (125) Google Scholar They raise concerns about the sex and age distribution of T gondii-HIV co-infection, and helminth infection as a risk factor in sub-Saharan Africa. Focusing on T gondii infection in HIV-infected people, our analyses were built around publicly available data. Unfortunately, only a few studies included data on sex and age. We reanalysed these data, and found no significant difference in T gondii infection between male (55·0%, 95% CI 35·4–74·7; 299/535) and female (53·0%, 30·4–75·6; 321/633) HIV-infected people in sub-Saharan Africa (OR 1·09, 0·48–2·49).2Wang ZD Liu HH Ma ZX et al.Toxoplasma gondii infection in immunocompromised patients: a systematic review and meta-analysis.Front Microbiol. 2017; 8: 389PubMed Google Scholar Evaluation of the effect of age on T gondii infection is hampered by different criteria of age grouping. However, prevalence of T gondii infection in HIV-infected people seems to increase with age, and a high prevalence is usually found in people age 35–50 years old, although the difference is not statistically significant.3Domingos A Ito LS Coelho E Lucio JM Matida LH Ramos Jr, AN Seroprevalence of Toxoplasma gondii IgG antibody in HIV/AIDS-infected individuals in Maputo, Mozambique.Rev Saude Publica. 2013; 47: 890-896Crossref PubMed Scopus (16) Google Scholar, 4Yohanes T Debalke S Zemene E Latent Toxoplasma gondii infection and associated risk factors among HIV-infected individuals at Arba Minch Hospital, South Ethiopia.AIDS Res Treat. 2014; 2014: 652941PubMed Google Scholar On the basis of our meta-analysis, no data on helminth infection were available. It is generally known that sub-Saharan Africa has the highest prevalence of helminth infections, where most countries are low-income.5Karagiannis-Voules DA Biedermann P Ekpo UF et al.Spatial and temporal distribution of soil-transmitted helminth infection in sub-Saharan Africa: a systematic review and geostatistical meta-analysis.Lancet Infect Dis. 2015; 15: 74-84Summary Full Text Full Text PDF PubMed Scopus (121) Google Scholar Our study showed a high prevalence of T gondii infection in HIV-infected people in sub-Saharan Africa and low-income countries compared with that in middle-income countries (p=0·027) or in high-income countries (p=0·026),1Wang ZD Wang SC Liu HH et al.Prevalence and burden of Toxoplasma gondii infection in HIV-infected people: a systematic review and meta-analysis.Lancet HIV. 2017; 4: e177-e188Summary Full Text Full Text PDF PubMed Scopus (125) Google Scholar which supports that helminth infection is a risk factor for T gondii infection in HIV-infected people in sub-Saharan Africa. We declare no competing interests. This work was supported by the National Natural Science Foundation of China (grant numbers 31672542, 31472183, 31372430, and 31230073). Prevalence and burden of Toxoplasma gondii infection in HIV-infected people: a systematic review and meta-analysisOur findings suggest that people with HIV infection have a very high burden of T gondii infection, especially in sub-Saharan Africa, and emphasise the importance of routine surveillance for T gondii infection in all HIV-infected people. Full-Text PDF Neglected risk factors for HIV and Toxoplasma gondii co-infectionZe-Dong Wang and colleagues1 did a systematic review and meta-analysis on T gondii co-infection in people with HIV. Their analysis showed that “HIV-infected people have a very high burden of T gondii infection, especially in sub-Saharan Africa and low-income countries“ compared with other regions and high-income countries. They suggested that this high prevalence might result from lack adequate access to sanitation facilities and safe water. However, the high burden of HIV–T gondii co-infection might be influenced by high prevalence of helminth infections in the same regions. Full-Text PDF Neglected risk factors for HIV and Toxoplasma gondii co-infectionZe-Dong Wang and colleagues analysed the prevalence of Toxoplasma gondii infection in HIV-infected people through systematic review and meta-analysis.1 The damage of infection with T gondii—an opportunistic parasite—is presented predominantly on two conditions: severe damage to the fetus caused by infection acquired during pregnancy and reactivation of latent disease in immunocompromised individuals, especially those with HIV.2 Thus, to capture the burden of T gondii infection in HIV-infected population is of great value in guidance of subsequent control. Full-Text PDF