Enteric infections as HIV indicator conditions for HIV testing: An umbrella review

The aim of this umbrella review was to explore whether faeco-oral sexually transmissible enteric infections should be indicator conditions for HIV testing.

Four bibliographical databases (Medline, Emcare, Embase, CINAHL) were searched in May 2026 for systematic reviews written in English, exploring HIV in people with faeco-oral sexually transmissible enteric infections. Two authors independently reviewed full-text publications, assessed risk of bias (Joanna Briggs toolkit) and performed a narrative synthesis to identify characteristics relevant to HIV indicator condition testing. Results were reported using the PRIOR guidelines and the review was registered on PROSPERO (ID:CRD420261387222).

There were 15 manuscripts in this umbrella review, all of which included study populations consisting exclusively of men who have sex with men (MSM). There were 10 032 MSM across 207 manuscripts that explored Shigella spp., Campylobacter spp., diarrhoeagenic E. coli, Salmonella spp., Giardia duodenalis, Entamoeba histolytica, Hepatitis A, Cryptosporidium spp., hepatitis E, Strongyloides stercoralis, Enterobius vermicularis, intestinal spirochaetosis (Brachyspiraspp.), Blastocystis spp. and enteric viruses. Living with HIV was observed in MSM with all enteric infections. Having a new diagnosis of HIV was seen in MSM with hepatitis A. Having Hepatitis B, Hepatitis C, syphilis and other (or previous) sexually transmitted infections (STI); visiting sex on premises venues, and engaging in chemsex were also observed in MSM with enteric infections.

These data provide the best evidence to date that faeco-oral sexually transmissible enteric infections in MSM are indicator diseases for HIV testing and testing for syphilis, hepatitis B and C and other STIs.