Prevalence, risk factors, and outcomes of infective endocarditis in people living with HIV: A systematic review and meta-analysis of intravenous drug use and microbiological profiles.
Year: 2026
Type: review
Study designs: Systematic Review, Meta-Analysis
Abstract: Background: Infective endocarditis (IE) poses a significant challenge in people living with human immunodeficiency virus (PLWH), with risk factors and outcomes potentially differing from HIV-negative counterparts. This systematic review and meta-analysis aimed to explore the prevalence, risk factors, mortality, and clinical characteristics of IE in PLWH versus HIV-negative patients. Methods: Six databases (PubMed, Web of Science, Scopus, ScienceDirect, Embase, and ProQuest) were searched up to January 2025 using terms including "Infective Endocarditis" and "Human Immunodeficiency Virus." Random-effects meta-analyses with Freeman-Tukey transformation were used to estimate pooled prevalence, mortality, and odds ratios (ORs) for IE by HIV status. Between-study heterogeneity (I²) and meta-regression were assessed to explore sources of variation. Results: Seventeen independent studies collectively reported 3,082 IE cases (2,095 among PLWH and 987 among HIV-negative individuals), analyzed as separate study-level data rather than a single combined cohort. The pooled prevalence of IE among PLWH was 33.2% (95% CI: 14.97-54.45%), with substantial heterogeneity (I² > 90%), highlighting the exploratory nature of these estimates. Among PLWH with IE, 85.5% (95% CI: 65.8-98.1%) reported intravenous drug use (IVDU), and 60-80% had right-sided IE (predominantly tricuspid valve), contrasting with left-sided predominance in HIV-negative patients. Mortality among PLWH with IE was 14.7%, compared with 22.3% in HIV-negative individuals. Staphylococcus aureus was the leading pathogen (24-73%). Conclusions: Given the high and persistent heterogeneity, findings should be interpreted as exploratory. PLWH with IE frequently exhibit IVDU and right-sided involvement, while mortality appears comparable to HIV-negative patients after accounting for IVDU, emphasizing behavioral rather than virologic determinants of risk.
Source: PubMed Central
Authors: Peyman Eini, Pooya Eini, Amin Doosti-Irani
Language: English
Subfield: Cardiology and Cardiovascular Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W7217087271