Prevalence and resistance patterns of Mycoplasma genitalium infection in people living with HIV: a systematic review and meta-analysis.

Objectives: This study aimed to estimate the prevalence of M. genitalium infection and understand the patterns of resistance associated mutations (resistance hereafter) in people living with HIV (PLWH).

Methods: We searched PubMed-MEDLINE, Embase and Web of Science to identify studies published as of 31st December 2023, reporting the prevalence of M. genitalium infection in PLWH. The pooled prevalence of M. genitalium infection and its resistance was calculated using random-effect models.

Results: Totally 66 studies involving 22,763 PLWH were included, with 5 studies reporting resistance. The overall pooled prevalence of M. genitalium infection in PLWH was 12% (95%CI: 9%-14%), which differed across geographic regions (P < 0.01), with the highest observed in North America (20%, 95%CI: 10%-32%). The pooled prevalence was the highest in female sex workers (FSW) living with HIV (20%, 95%CI: 10%-32%), but without statistical difference between different population groups (P = 0.76). The pooled prevalence of macrolide resistance-mediating mutations (MRMMs), quinolone resistance-determining regions (QRDRs) mutations, and multidrug resistance with MRMMs and QRDRs mutations in PLWH was 36% (95%CI: 5%-77%), 25% (95%CI: 8%-47%), and 20% (95%CI: 12%-29%), respectively.

Conclusion: The prevalence of M. genitalium infection in PLWH in this study was lower than HIV pre-exposure prophylaxis users and FSW, but higher than men who have sex with men in the community. There's substantial geographic variation in the prevalence of M. genitalium infection in PLWH. The variability reflects differences in exposure risks as well as the testing/treatment strategies in place for sexually transmitted infections.

Prospero registration number: CRD42023480798.