Diagnostic accuracy of tests for visceral leishmaniasis caused by Leishmania infantum: A systematic review and meta-analysis.

This systematic review assessed the diagnostic accuracy of tests for visceral leishmaniasis (VL) caused by Leishmania infantum in individuals with suspected disease, including people living with HIV and other immunocompromising conditions. Nineteen studies met the inclusion criteria, eight of which included VL-HIV coinfected patients. Among immunocompetent individuals, rapid diagnostic tests (RDTs) and kDNA-PCR showed the highest accuracy compared with parasitological reference methods, with diagnostic odds ratios (DORs) of 556.6 (95% CI 203.1-1525.3) and 262.4 (95% CI 48.4-1422.0), respectively. In people living with HIV, serological tests showed reduced performance, particularly indirect immunofluorescence assay (IFA) (DOR 17.2; 95% CI 1.7-172.5) and RDTs (DOR 41.3; 95% CI 9.3-182.8), whereas PCR performed better (DOR 102.6; 95% CI 19.2-546.9). These findings support RDTs as first-line tests for immunocompetent patients and highlight the need for complementary molecular or parasitological methods in people living with HIV.