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A global overview of microsporidia infection in HIV/AIDS patients: an updated systematic review and meta-analysis

Ali Asghari1, Mohammad Reza Mohammadi2, Roumina Norouzi3

  • 1Medical Microbiology Research Center, Qazvin University of Medical Sciences, Qazvin, Iran.

International Health
|January 28, 2026
PubMed
Abstract

Insights

Microsporidia infections are common in human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) patients, affecting 12% globally. Early detection and integrated care are crucial for managing this opportunistic pathogen.

Area of Science:

  • Infectious Diseases
  • Parasitology
  • Immunology

Background:

  • Microsporidia are opportunistic pathogens frequently affecting immunocompromised individuals.
  • Human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) patients are particularly susceptible to microsporidial infections.
  • Updated global estimates on microsporidia prevalence and distribution in HIV/AIDS patients are needed.

Purpose of the Study:

  • To provide updated global estimates of microsporidia prevalence in human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) patients.
  • To determine the species and genotype distribution of microsporidia in this population.
  • To identify clinical correlates associated with microsporidial infections in HIV/AIDS patients.

Main Methods:

  • A systematic literature search was performed across international databases for studies published between January 2017 and October 2025.
  • Pooled prevalence and odds ratios (ORs) were calculated using random-effects meta-analysis with 95% confidence intervals (CIs).
  • Studies were categorized by publication date, sample size, CD4 counts, and patient demographics.

Main Results:

  • Thirty-nine studies from 18 countries were included, revealing a pooled microsporidia prevalence of 12% in HIV/AIDS patients, significantly higher than controls (1.9%).
  • Higher prevalence was noted in studies post-2020 (15.9%), smaller sample sizes (19.2%), CD4 counts ≤200 cells/μl (58.4%), and in males (64.9%).
  • Enterocytozoon bieneusi was the predominant species, with high country-specific prevalence in Malaysia (60.9%), Mexico (48.3%), Malawi (37.0%), and South Africa (32.9%).

Conclusions:

  • Microsporidia remain a significant opportunistic pathogen in HIV/AIDS patients worldwide.
  • Strengthened molecular surveillance and standardized diagnostic protocols are essential.
  • Integrating microsporidia screening into routine HIV/AIDS care can improve patient outcomes and control transmission.
Keywords:
HIVgenotypemicrosporidiaprevalencespeciessystematic review

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