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.
- 1Infectious Disease Research Center, Hamadan University of Medical Sciences, Hamadan, Iran.
- 2Cardiovascular Research Center, Rajaie Cardiovascular Institute, Tehran, Iran.
- 3Research Center for Health Sciences, Hamadan University of Medical Sciences, Hamadan, Iran.
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
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
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.
Related
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BibTeX
@article{eini2026prevalence,
title = {{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.}},
author = {Peyman Eini and Pooya Eini and Amin Doosti-Irani},
journal = {Caspian journal of internal medicine},
year = {2026},
month = sep,
doi = {10.22088/cjim.17.3.494},
url = {https://europepmc.org/article/MED/42923611},
note = {CC BY-NC},
}
RIS
TY - JOUR
TI - 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.
AU - Peyman Eini
AU - Pooya Eini
AU - Amin Doosti-Irani
PY - 2026
DA - 2026/09/01
JO - Caspian journal of internal medicine
DO - 10.22088/cjim.17.3.494
UR - https://europepmc.org/article/MED/42923611
AB - 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 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 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.
SN - 2008-6164
SN - 2008-6172
ER -