{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,29]],"date-time":"2026-10-29T01:13:53Z","timestamp":1793236433580,"version":"4.5.0"},"reference-count":52,"publisher":"Oxford University Press (OUP)","issue":"8","license":[{"start":{"date-parts":[[2021,2,12]],"date-time":"2021-02-12T00:00:00Z","timestamp":1613088000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"DOI":"10.13039\/501100000272","name":"U.K. National Institute for Health Research","doi-asserted-by":"crossref","award":["RP-2017-08-ST2-012"],"award-info":[{"award-number":["RP-2017-08-ST2-012"]}],"id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/100000060","name":"National Institute of Allergy and Infectious Diseases","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000060","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["F32AI140511"],"award-info":[{"award-number":["F32AI140511"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,7,14]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:p>Background: The epidemiology of Pneumocystis jirovecii, known to colonize the respiratory tract and cause a life-threatening HIV-associated pneumonia (PCP), is poorly described in Africa. We conducted a systematic review to evaluate P. jirovecii prevalence in African HIV-positive adults with or without respiratory symptoms. Methods: We searched Medline, Embase, Cochrane library, Africa-Wide, and Web of Science for studies employing PCR and\/or microscopy for P. jirovecii detection in respiratory samples from HIV-positive adults in Africa between 1995 and 2020. Prevalence with respiratory symptoms was pooled using random-effect meta-analysis, and stratified by laboratory method, sample tested, study setting, CD4 count, and trimethoprim\/sulfamethoxazole prophylaxis. Colonization prevalence in asymptomatic adults and in adults with non-PCP respiratory disease was described, and quantitative PCR (qPCR) thresholds to distinguish colonization from microscopy-confirmed PCP reviewed. Results: Thirty-two studies were included, with 27 studies (87%) at high risk of selection bias. P. jirovecii was detected in 19% [95% confidence interval (CI): 12\u201327%] of 3583 symptomatic and in 9% [95% CI: 0\u201345%] of 140 asymptomatic adults. Among symptomatic adults, prevalence was 22% [95% CI: 12\u201335%] by PCR and 15% [95% CI: 9\u201323%] by microscopy. Seven percent of 435 symptomatic adults had PCR-detected Pneumocystis colonization without evidence of PCP [95% CI: 5\u201310%, four studies]. One study established a qPCR cutoff of 78 copies\/5\u03bcl of DNA in 305 induced sputum samples to distinguish Pneumocystis colonization from microscopy-confirmed PCP. Conclusion: Despite widened access to HIV services, P. jirovecii remains common in Africa. Prevalence estimates and qPCR-based definitions of colonization are limited, and overall quality of studies is low.<\/jats:p>","DOI":"10.1093\/mmy\/myab002","type":"journal-article","created":{"date-parts":[[2021,1,9]],"date-time":"2021-01-09T14:34:19Z","timestamp":1610202859000},"page":"802-812","source":"Crossref","is-referenced-by-count":25,"title":["The prevalence of laboratory-confirmed <i>Pneumocystis jirovecii<\/i> in HIV-infected adults in Africa: A systematic review and meta-analysis"],"prefix":"10.1093","volume":"59","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9471-5397","authenticated-orcid":false,"given":"Nicola K","family":"Wills","sequence":"first","affiliation":[{"name":"Welcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, 7925, South Africa"},{"name":"Department of Clinical Research, Faculty of infectious and Tropical Diseases, London School of Hygiene and Tropical 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