Prevalence of HIV infection among visceral leishmaniasis patients in India: A systematic review and meta-analysis

Background: Visceral leishmaniasis (VL) and HIV coinfection constitute a growing public health challenge, especially in VL-endemic regions. In 2020, India represented 18 % of the global VL burden and held the world's third-largest burden of HIV infection. This study aimed to systematically assess the prevalence of HIV infection among VL patients in India, providing insight into the epidemiological landscape of these concomitant diseases. Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, an exhaustive search of PubMed, Embase, Scopus, and Google Scholar was performed, including articles published until June 2022. The random-effects model was utilized for estimating overall prevalence, and subgroup analysis was performed based on the study region. R software (version 4.2.2) was used for analysis. Results: This review included five studies, with publication years ranging from 2006 to 2021. The analysis involved 20,835 individuals diagnosed with VL, among whom 726 tested positive for HIV. The overall estimated prevalence of HIV infection among VL patients in India was 3.4 % (95 % CI: 2.0-5.8 %). However, there was substantial heterogeneity among the studies (I-2 = 98 %, p < 0.01). Subgroup analysis demonstrated prevalence rates in Bihar at 3.1 % (95 % CI: 1.7-5.7 %) and in New Delhi at 5.8 % (95 % CI: 2.1-12.1 %), with no statistically significant difference between these regions (p = 0.22). Conclusion: The study found low yet substantial prevalence of HIV infection in VL patients. To combat this dual health challenge, proactive measures, including integrated interventions, surveillance, and collaboration between VL and HIV programs, are essential to improve case identification and control.