Burden of malaria-HIV coinfection and associated adverse outcomes in Ethiopia: a systematic review and meta-analysis

Abstract Background The co-occurrence of malaria and HIV represents a significant health crisis in sub-Saharan Africa, particularly in Ethiopia, where both diseases are prevalent. This synergistic burden aggravates health inequalities, strains healthcare infrastructure, and challenges socioeconomic stability. Investigating the relationship between these co-infections is crucial for enhancing treatment, prevention, diagnosis, and control strategies for malaria in individuals living with HIV. Therefore, this systematic review and meta-analysis aimed to determine the overall burden of malaria-HIV co-infection, as well as the rates of severe anemia, hyperparasitemia, and CD4 + T-cell counts. Methods A comprehensive literature search was conducted using several electronic databases, including PubMed, Science Direct, Scopus, and Cochrane, as well as search engines like Google Scholar. A random-effects model was used to calculate pooled burden estimates. Subgroup analysis and funnel plots were utilized to evaluate heterogeneity and publication bias, respectively. Result Of the 429 studies initially reviewed, ten articles met the criteria for inclusion in the final analysis. The pool prevalence estimate of malaria-HIV co-infection was 9% (95% CI 3–15). When grouped by the year of conduct, studies from 2013 to 2025 exhibited the highest malaria burden at 10% (95% CI -4-24), while those conducted from 2002 to 2012 showed the lowest burden at 9% (95% CI 1–16). The overall combined prevalence rates for specific clinical conditions were 31% (95% CI 12–50) for severe anemia, 41% (95% CI -8-90) for hyperparasitemia, and 35% (95% CI 14–56) for low CD4 counts (≤ 200 cells/µL). Conclusion This meta-analysis found that the overall burden of malaria-HIV co-infection in Ethiopia is 9%.