Caspian Journal of Internal Medicine

en 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 Infectious Diseases Infectious Diseases Review Article Review Article Background: Infective endocarditis (IE) poses a significant challenge in PLWH, with risk factors and outcomes potentially differing from HIV-negative counterparts. This systematic review and meta-analysis aimed to assess the prevalence, risk factors, mortality, and clinical characteristics of IE in PLWH versus HIV-negative patients. Methods: We searched six databases (PubMed, Web of Science, Scopus, ScienceDirect, Embase, ProQuest) using terms including "Infective Endocarditis" and "Human Immunodeficiency Virus," identifying 758 records. After removing 360 duplicates and screening 398 records, 56 full-text articles were assessed, with 22 studies included. Meta-analyses estimated IE prevalence in PLWH, IVDU prevalence, in-hospital mortality, and odds ratios (ORs) for IE by HIV status, using random-effects models with Freeman-Tukey transformation. Heterogeneity (I²) and publication bias (Forest plots, Egger’s test) were evaluated. Results: The pooled IE prevalence in PLWH was 28.9% (95% CI: 20.7–38.7%, I² = 97.5%). IVDU prevalence was 79.6% (95% CI: 62.9–92.1%) in PLWH and 67.8% (95% CI: 33.9–93.8%) in HIV-negative IE patients, linked to right-sided IE (e.g., 80.4% HIV+). Staphylococcus aureus predominated, with atypical pathogens more common in PLWH cases. In-hospital mortality was 16.9% (95% CI: 11.5–23.0%) in PLWH and 14.6% (95% CI: 7.5–23.7%) in HIV-negative patients, with IVDU-adjusted RR of 1.34 (95% CI: 1.03–1.75). The OR for IE by HIV status was 1.18 (95% CI: 0.25–5.53). High heterogeneity and potential bias were noted. Conclusion: PLWH with IE exhibit high IVDU prevalence and pulmonary manifestations, but mortality aligns with HIV-negative patients when adjusted for IVDU, emphasizing the role of behavioral risk factors over HIV status alone.   Infective Endocarditis, Human Immunodeficiency Virus (HIV), Intravenous Drug Use (IVDU), Prevalence, Mortality 2 0 http://caspjim.com/browse.php?a_code=A-10-3370-6&slc_lang=en&sid=1 peyman eini eini@umsha.ac.ir 100319475328460057090 100319475328460057090 No Infectious Disease Research Center, Hamadan University of Medical Sciences, Hamadan, Iran pooya eini pooyaeini.pe@gmail.com 100319475328460057091 100319475328460057091 Yes Cardiovascular Research Center, Rajaie Cardiovascular Institute, Tehran, Iran amin Doosti-Irani doostiiraniamin@gmail.com 100319475328460057092 100319475328460057092 No Research Center for Health Sciences, Institute of Health Sciences and Technologies, Avicenna Health Research Institute, Hamadan University of Medical Sciences, Hamadan, Iran