Prevalence of Enteric Bacteria Among People Living with HIV (PLHIV), with Diarrhea: Systematic Review and Meta-Analysis

A BSTRACT Human immunodeficiency virus (HIV) continues to be a major global health concern, particularly due to its association with opportunistic infections such as persistent diarrhea caused by enteric pathogens. In resource-limited settings, such infections contribute significantly to morbidity and mortality. Although multiple primary studies have explored the relationship between HIV and enteric bacterial infections, a comprehensive pooled analysis remains lacking. This systematic review and meta-analysis aimed to determine the pooled prevalence of enteric bacteria among people living with HIV (PLHIV) who experience diarrhea. The study was registered in PROSPERO (CRD42023432942) and followed PRISMA guidelines. A systematic search of PubMed, EMBASE, Web of Science, and ProQuest databases was conducted using defined search terms. Eligible studies were screened and appraised using the Joanna Briggs Institute (JBI) quality checklist. Data were synthesized using a random-effects model in R software, and heterogeneity was assessed via the I² statistic. From an initial 703 articles, 41 studies from 18 countries met inclusion criteria. The pooled prevalence of enteric bacteria among PLHIV with diarrhea was 42% (95% CI: 25%–61%), with high heterogeneity (I² = 90%, p < 0.01). Subgroup analyses by continent showed regional variation, while meta-regressions based on age, sample size, and study year showed no significant associations. The Doi plot revealed asymmetry, and an LFK index of 1.71 suggested potential publication bias. This study highlights a substantial burden of enteric bacterial infections in PLHIV with diarrhea and underscores the need for improved diagnostic, preventive, and management strategies tailored to vulnerable populations, particularly in low-resource settings.