The prevalence of latent and acute toxoplasmosis in HIV-infected pregnant women: A systematic review and meta-analysis

Objective: HIV in pregnancy is not only important for mother-to-child HIV transmission, but also it assumes additional importance because HIV increases susceptibility to opportunistic infections, leading to increased morbidity and mortality in mothers and neonates. Toxoplasmosis is one of the most important opportunistic infections in HIV-infected pregnant women. The present study was undertaken to assess the prevalence of latent toxoplasmosis (LT) and acute toxoplasmosis (AT) infection in HIV-infected pregnant women. Methods: PubMed/MEDLINE, Scopus, Web of Science, EMBASE and SciELO were searched to identify relevant studies. A random-effects model was used to estimate the overall and subgroup-pooled prevalences across studies. Heterogeneity between studies was assessed via the I-2 test. Results: A total of 14 articles that included 3256 subjects in nine countries met the inclusion criteria. The overall prevalence rates of LT and AT in HIV-infected pregnant women were 45.7% (95% CI, 32.3-59.7%) and 1.1% (95% CI, 0.4-3.2%), respectively. The findings indicate that, worldwide, approximately 559,000 and 13,450 HIV-infected pregnant women are affected by LT and AT, respectively. From this review, it is estimated that approximately 3432 babies annually could be born with congenital toxoplasmosis (CT) from HIV-infected pregnant mothers. Conclusions: The present study indicates that a large number of HIV-infected mothers are affected by LT and AT. This can lead to adverse complications such toxoplasmic encephalitis in mothers and CT in neonates. Our results suggest a need for screening programs using well-validated diagnostic platforms for both LT and AT for all HIV infected pregnant women.