The association between antimicrobial resistance and HIV infection: a systematic review and meta-analysis

Abstract Background People living with HIV (PLWH) are at increased risk of infections with resistant organisms due to more frequent healthcare utilisation. Objectives investigate the association between HIV and antimicrobial resistance (AMR). Data sources we searched MEDLINE, EMBASE, Web of Science, LILACS and African Journals Online. Study eligibility criteria Studies reporting on AMR for colonisation or infection with bacterial pathogens excluding mycobacteria and bacteria causing sexual transmitted infections stratified by HIV status, species and antimicrobials tested. Participants any. Interventions none. Methods Pooled odds ratios were used to evaluate the association between HIV and resistance. Results A total of 92 studies published between 1995 and 2020 were identified. The studies included the following organisms: Staphylococcus (n=47), Streptococcus pneumoniae (n=28), Escherichia coli (n=6) and other Gram-negative bacteria. PLWH had a 2.12 (95% CI 1.36-3.30) higher odds for colonization and 1.90 (95%CI 1.45-2.48) higher odds for infection with methicillin-resistant S. aureus; a 2.28 (95%CI 1.75-2.97) higher odds of infections with S. pneumoniae with decreased penicillin susceptibility and a 1.59 (95%CI 0.83-3.05) higher odds of resistance to third-generation cephalosporins in E. coli and Klebsiella pneumoniae. Conclusion . This review shows an increased risk of AMR in PLWH across a range of bacterial pathogens and multiple drug classes. The lack of laboratory capacity for identifying AMR and limited access to alternative treatment options in countries with the highest burden of HIV highlights the need for more research on AMR in PLWH. Overall, the quality of studies was moderate or low which may impact the findings of this review.