The outcomes of cryptococcal disease in HIV-positive individuals following COVID-19 infection: A systematic review and meta-analysis

IF 4 3区医学 Q1 INFECTIOUS DISEASES

Journal of Infection and Public Health Pub Date : 2025-08-24 DOI:10.1016/j.jiph.2025.102941

Israa Abdullah Malli , Sarah Ali Alqhtani , Hannah Ghazi Abid , Norah Ali Alqhtani , Ghaida Essa Alharbi , Lamar Hassan Aboaljadiel , Roza Khalid Alharbi , Tala Habib Aletani , Taif Mohammed Alamri

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引用次数: 0

Abstract

Background

Cryptococcal disease is considered a major cause of morbidity in individuals with HIV in resource-limited settings. The long-term effects of COVID-19 and cryptococcal coinfection among people living with HIV (PLWHIV) have not been thoroughly investigated. This study examined the incidence of cryptococcosis among HIV-positive individuals following COVID-19.

Methods

A thorough search was conducted across five databases on November 14, 2023, and updated on May 7, 2024. Observational and case reports on the clinical and pathological outcomes of cryptococcosis in HIV-positive individuals with COVID-19 were eligible. The authors extracted the study characteristics and main outcomes: mortality, prevalence, AIDS-defining diseases, combined cryptococcosis, and COVID-19 impact on hospitalization, in a standard Excel sheet.

Results

Of the 752 identified articles (40 in the initial search and six in the updated search), eight were selected. The minimum follow-up duration varied between the research periods, which was three months. The investigations comprised 5751 PLWHIV: 3830 were COVID-19-positive, 130 developed cryptococcosis, and two case reports revealed individuals with concomitant HIV, COVID-19, and cryptococcal infections. The meta-analysis pooled risk ratio (RR) for incidence was 0.21 (90 % confidence interval [CI]: 0.04–1.31) with high heterogeneity (I ² = 98 %), while the pooled risk for mortality was 1.49 (95 % confidence interval: 0.60–3.72), with moderate heterogeneity (I² = 65 %). The chi-squared test for heterogeneity (X² = 125.62, p-value <0.00001) revealed considerable variation.

Conclusions

Cryptococcosis remains a rare but significant complication for PLWHIV following the COVID-19 infection. The data suggests a decrease in incidence risk while a probable increase in mortality. The observed heterogeneity and variability address the importance of enhanced surveillance and targeted interventions for this vulnerable population. Further research is essential to identify factors contributing to heterogeneity and develop effective strategies for managing cryptococcosis in PLWHIV.

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COVID-19感染后hiv阳性个体隐球菌病的结局：系统回顾和荟萃分析

背景：在资源有限的环境中，隐球菌病被认为是艾滋病毒感染者发病的主要原因。COVID-19和隐球菌合并感染对艾滋病毒感染者（PLWHIV）的长期影响尚未得到彻底调查。本研究调查了COVID-19后hiv阳性个体中隐球菌病的发病率。方法于2023年11月14日对5个数据库进行全面检索，并于2024年5月7日更新。hiv阳性的COVID-19患者隐球菌病的临床和病理结果的观察报告和病例报告均符合条件。作者在一个标准的Excel表格中提取了研究特征和主要结果：死亡率、患病率、艾滋病定义疾病、联合隐球菌病和COVID-19对住院的影响。结果在752篇确定的文章中（初始检索40篇，更新检索6篇），有8篇入选。研究期间的最短随访时间各不相同，为三个月。共有5751例感染者感染了新冠病毒，3830例感染了新冠病毒，130例感染了隐球菌病，2例报告同时感染了HIV、新冠病毒和隐球菌病。发病率的meta分析合并风险比（RR）为0.21(90 %置信区间[CI]: 0.04-1.31)，异质性高（I2 = 98 %），死亡率的meta分析合并风险比（RR）为1.49(95 %置信区间：0.60-3.72)，异质性中等（I2 = 65 %）。异质性的卡方检验（X2 = 125.62， p值<；0.00001）显示了相当大的差异。结论隐球菌病是新型冠状病毒感染后PLWHIV患者罕见但重要的并发症。数据表明，发病率风险降低，但死亡率可能增加。观察到的异质性和可变性说明了加强对这一弱势群体的监测和有针对性干预的重要性。进一步的研究是必要的，以确定导致异质性的因素，并制定有效的策略来管理PLWHIV中的隐球菌病。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Infection and Public Health PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH -INFECTIOUS DISEASES

CiteScore

13.10

自引率

1.50%

发文量

203

审稿时长

96 days

期刊介绍： The Journal of Infection and Public Health, first official journal of the Saudi Arabian Ministry of National Guard Health Affairs, King Saud Bin Abdulaziz University for Health Sciences and the Saudi Association for Public Health, aims to be the foremost scientific, peer-reviewed journal encompassing infection prevention and control, microbiology, infectious diseases, public health and the application of healthcare epidemiology to the evaluation of health outcomes. The point of view of the journal is that infection and public health are closely intertwined and that advances in one area will have positive consequences on the other. The journal will be useful to all health professionals who are partners in the management of patients with communicable diseases, keeping them up to date. The journal is proud to have an international and diverse editorial board that will assist and facilitate the publication of articles that reflect a global view on infection control and public health, as well as emphasizing our focus on supporting the needs of public health practitioners. It is our aim to improve healthcare by reducing risk of infection and related adverse outcomes by critical review, selection, and dissemination of new and relevant information in the field of infection control, public health and infectious diseases in all healthcare settings and the community.