Telomeres, the protective caps at the ends of chromosomes, are crucial in maintaining genomic stability and cellular longevity. These specialised DNA-protein structures prevent chromosome degradation, fusion, and recognition as damaged DNA, thereby safeguarding the integrity of the genetic material (Lee et al., 2025). Telomeres consist of repetitive nucleotide sequences, typically TTAGGG in vertebrates, which are bound by a complex of proteins known as shelterin. This complex shields the telomeric DNA from DNA repair mechanisms and regulates telomere length (Mir et al., 2020). The shelterin complex also facilitates the formation of a protective loop structure (t-loop), further stabilising the telomere (Dufourd et al., 2025). Without telomeres, chromosomes would be susceptible to damage and degradation, resulting in genomic instability and cellular dysfunction. Telomere length (TL) is dynamic and progressively shortens with each successive cell division due to the end-replication problem (Bonnell et al., 2021). While telomerase, a specialised reverse transcriptase, replenishes telomeric DNA in germline cells, stem cells, and some immune cells, its activity is limited in most somatic cells (Lee et al., 2025). Consequently, telomere shortening serves as a biological clock of cellular ageing. Critically short telomeres activate DNA damage pathways, inducing replicative senescence or apoptosis (Eller et al., 2002; Koliada et al., 2015; Zahid, 2023). These processes contribute to tissue dysfunction and age-related diseases, including cardiovascular, metabolic, and neurodegenerative disorders. In the immune system, TL influences the replicative lifespan of lymphocytes, shaping adaptive immunity and susceptibility to disease (Chebly et al., 2023; Heba et al., 2021).

Telomere shortening, driven by cell division and limited telomerase activity, accelerates immune ageing and increases susceptibility to infectious diseases. (Chebly et al., 2023; Nassour et al., 2024). Chronic infections like HIV and tuberculosis exacerbate telomere attrition through sustained immune activation and oxidative stress (Adelakun et al., 2022). Immunosenescence, the age-related decline in immune function, is influenced by telomere shortening (Heba et al., 2021).

Rising evidence supports an interplay between infectious diseases and telomere dynamics (Ilmonen et al., 2008). Acute infections trigger robust immune activation, necessitating rapid clonal expansion of T and B cells, thereby accelerating telomere erosion (Chebly et al., 2023; Fali et al., 2019). Malaria infection remains the top global health challenge, affecting millions of people especially in subsaha Africa (Venkatesan, 2025; Olasehinde et al., 2019). Similar associations are evident in malaria, where infection-induced inflammation may accelerate telomere shortening, yet human studies remain limited compared to animal models ((Asghar et al., 2017; Miglar, 2023; Miglar et al., 2021; Wakai et al., 2025a)). Chronic infections such as HIV, hepatitis, or tuberculosis sustain prolonged immune activation, compounding telomere attrition and leading to premature immune senescence (Adelakun et al., 2022; Macamo et al., 2024; Wang et al., 2019). Oxidative stress and systemic inflammation, hallmarks of chronic infection, further exacerbate telomere erosion (Correia-Melo et al., 2014). Similar associations are evident in malaria (Miglar et al., 2021; Miglar et al., 2020), Bacterial (Noppert et al., 2020) and other viral infections such as COVID-19 (Aviv, 2020). Thus, telomere biology provides mechanistic insights into immune exhaustion and pathogen persistence.

Despite growing evidence connecting telomere dynamics with infectious diseases, the evolution of knowledge in this area has not yet been systematically mapped (Tunnicliffe et al., 2024). Bibliometric analysis provides a valuable tool for evaluating the development of research fields by quantifying publication output, collaboration networks, and citation patterns, thereby identifying global trends and gaps. In health sciences, this approach enables assessment of scientific influence, research performance, and thematic directions across countries and institutions (Tomaszewski, 2023). Applied here, it can uncover how telomere biology has been investigated in relation to infectious diseases, which pathogens and mechanisms have drawn the most attention, and where critical, underexplored areas remain (Afolabi et al., 2021). A bibliometric review published in 2020 (Valera-Gran et al., 2020) examined research on telomere length in children, and a systematic review has explored the relationship between infection and telomere length (Tunnicliffe et al., 2024). However, no study has comprehensively assessed telomere length in the context of infectious diseases. As a result, the scope, growth, and impact of research in this area remain unclear. This study analyses global research output on telomere biology and infectious diseases, maps research trends, and highlights thematic areas that can inform future scientific inquiry. By integrating bibliometric mapping with mechanistic interpretation, this review elucidates how telomere biology regulates immune homeostasis during infection and influences pathogen persistence within host–pathogen interactions.

This bibliometric review synthesises 2 decades of research linking telomere biology with infectious diseases. The 2005–2025 period was chosen to capture the emergence of pivotal studies linking telomere dynamics to infectious diseases, as well as advancements in bibliometric tools such as VOSviewer, which enable robust analysis of research trends (Pranckutė, 2021). The objectives are:

To quantify publication trends and assess the growth trajectory of the field.

This review focuses on human-relevant studies, excluding animal models unless they provide direct translational insights into human telomere dynamics (e.g., Asghar et al., 2015).

We searched the Web of Science (WoS) Core Collection for publications between 1 January 2005, and 20 July 2025. Search terms combined telomere biology and infectious disease constructs:

TS = (“telomere length” OR “telomere dynamics” OR “telomerase activity” OR “telomere shortening” OR “telomere attrition”)

AND TS = (“infectious disease*” OR “viral infection*” OR “bacterial infection*” OR “parasitic infection*” OR malaria OR HIV OR tuberculosis OR COVID-19 OR “chronic infection*” OR “acute infection*”)

AND TS = (“immune response” OR inflammation OR “oxidative stress” OR “leukocyte telomere length” OR “host-pathogen interaction”).

Only peer-reviewed articles and reviews in English with full bibliographic metadata were included.

This bibliometric review was conducted using the Advanced Search tool in the Web of Science (WoS) (https://www.webofscience.com/wos/woscc/advanced-search) Core Collection as the sole data source.

WoS was selected because it offers comprehensive coverage of high-impact journals, robust citation indexing, and consistent metadata formatting that facilitates advanced bibliometric analyses (Pranckutė, 2021; Vijayan DrSS, 2021; Web of Science, 2024). In addition, WoS provides backward and forward citation tracking with high reliability, which is essential for co-citation, co-authorship, and keyword network mapping (Yan and Zhiping, 2023). Although other databases, such as Scopus, PubMed, and Dimensions, index additional journals, they often present challenges, including inconsistent metadata, limited historical coverage, and increased risk of duplication when datasets are merged (Guerrero-Bote et al., 2021). Prior bibliometric studies have established WoS as the gold standard due to its compatibility with widely used software tools such as VOSviewer and CiteSpace (Tomaszewski, 2023; Web of Science, 2024). Therefore, restricting the dataset to WoS ensures both methodological rigour and comparability with similar bibliometric reviews (Klarin, 2024).

The following criteria were applied to exclude studies that did not align with the research focus on the relationship between telomere dynamics and infectious diseases in human-relevant contexts:

Studies unrelated to infectious diseases

From Web of Science, we extracted metadata including publication year, authorship, journal, institutional affiliation, country, keywords, and citations, as this database provides standardised and comprehensive metadata for bibliometric studies (Klarin, 2024). The analyses utilised:

VOSviewer for co-authorship, co-citation, and keyword clustering, enabling visualisation of scientific networks and thematic relationships (van Eck and Waltman, 2010).

VOSviewer was configured with a minimum of five co-occurrences for keywords and 10 citations for co-citation analysis, using fractional counting for clustering. CiteSpace employed a time-slicing approach (2005–2025) with a minimum burst strength of 2 for trend detection (van Eck and Waltman, 2010; Chen, 2006).

Quality control measures included manual screening to remove duplicates, verification of metadata accuracy (e.g., author affiliations, publication years) via Web of Science records, and exclusion of retracted articles to ensure data integrity (Guerrero-Bote et al., 2021).

From 1 January 2005, to 20 July 2025, a total of 123 publications related to telomere length dynamics and infectious diseases were identified. Figure 1 depicts the annual growth of these publications, highlighting a gradual increase in a in scholarly interest has emerged in recent years. The refined dataset of 123 publications, after applying exclusion criteria, forms the basis for this numbers-based analysis, which ensured our focus on high-quality, relevant studies.

An analysis of publication types was conducted to assess the composition of the scholarly output within the retrieved literature. Figure 2 presents the distribution of publications by document type, showing that research articles constitute the majority of the literature (n = 94; 76.4%), followed by review articles (n = 26; 21.1%). Book chapters (n = 2; 1.6%) and conference proceedings (n = 1; 0.8%) contribute only marginally to the overall publication output.

To understand the dissemination of research on telomere length in infectious diseases, we examined the journals that have contributed most actively to this field. Key outlets included Frontiers in Immunology, PLoS ONE, Scientific Reports, AIDS, Cells, and Immunity & Ageing. Table 1 summarises these journals’ total publications, citations, impact factors, and quartiles. For example, PLoS ONE published nine articles garnering 444 citations, while Frontiers in Immunology hosted six articles with 425 citations. The journals represented spanned the first (Q1) and second quarters (Q2).

Key journals were identified by ranking sources in VOSviewer according to publication volume, with a minimum threshold of two publications. Citation metrics, impact factors, and journal quartiles were then considered to highlight the most influential outlets. Together, the top ten journals contributed 43 publications, representing about 35 percent of the total dataset, and underscoring their important role in disseminating research in this field.

To examine the intellectual structure and disciplinary foundations of research on telomere biology in infectious diseases, a journal co-citation analysis was performed. This approach identifies influential journals and reveals how knowledge is shared across related scientific domains. Figure 3 illustrates the resulting co-citation network, highlighting interconnected clusters that reflect cross-disciplinary linkages among immunology, infectious disease, and molecular biology.

Analysis of publication contributions identifies several leading researchers. Côté HCF from Université de Montréal, Canada, contributed the highest number of publications (n = 9), followed by Pick N from the University of British Columbia, Canada (n = 8), and Maan EJ from British Columbia Women’s Hospital, Canada (n = 6). Key contributors include Money DM, Soudeyns H, Arribas JR, Bitnun A, Brophy J, Kakkar F, and Lin J, each with 4–5 publications (see Table 2 for detailed affiliations and counts). Canadian institutions dominate the research landscape, with strong collaborative ties evident among these authors. Figure 4, a co-authorship density map, visualises these networks, highlighting dense clusters of collaboration among Canadian researchers in HIV-related studies.

To explore the collaborative structure within the field, co-authorship networks were analysed. Figure 4 visualises these networks, revealing concentrated clusters of collaboration among Canadian researchers, with strong links to international partners. The map highlights that research efforts are predominantly oriented toward HIV-related studies, reflecting both the intensity and specialization of scholarly activity in this domain.

The United States (29.3%), Canada (12.2%), and Spain (8.9%) topped publication outputs, with additional contributions from China, Italy, Brazil, France, Iran, Serbia, and Switzerland. Table 3 provides publication counts, single-country versus multi-country collaborations, and percentages. The United States led with 36 publications, including 10 international collaborations, while Canada contributed 15 nationally focused publications. Spain showed a high rate of multi-country collaboration (45.5%).

To visualise the global distribution of research output in telomere biology and infectious diseases, a geographical mapping analysis was conducted. This analysis highlights regional contributions and reveals disparities in scientific productivity across countries and institutions worldwide.

Global geographical distribution of scientific publications on telomere length dynamics and infectious diseases. Darker shades of blue indicate higher research output, with prominent contributions from the United States, Canada, Western Europe, China, and Australia.

To identify the leading institutional contributors to research on telomere biology and infectious diseases, an institutional productivity and collaboration analysis was performed. This analysis highlights key research centres that play a central role in shaping the field, as shown in Figure 5.

Institutional distribution of scientific publications on telomere length dynamics and infectious diseases, highlighting major research centres, including the University of British Columbia, Université de Montréal, and the University of California, San Francisco.

Citation analysis revealed key studies that have significantly shaped the research landscape on telomere biology and infectious diseases. The most highly cited work, The most highly cited work, Moro-García and Co (Moro-García et al., 2018) with 158 citations, explored the influence of inflammation on T lymphocyte differentiation. With 133 citations, which examined the relationship between aerobic fitness and immune ageing; and (Spielmann et al., 2011), another with 130 citations, which investigated the mechanisms of immunosenescence (Rodriguez et al., 2021). The top 10 cited works, their sources, and annual citation rates are summarised in Table 4.

To identify dominant research themes and emerging topics in the literature, a keyword-based thematic analysis was conducted using authors’ keywords. A word cloud visualization was generated to capture the most frequently occurring terms and to highlight prevailing areas of focus within the field.

A word cloud visualization (Figure 6) was generated from the authors’ keywords set to a maximum of 50 terms. Following a minimum occurrence threshold of five, 35 keywords met the inclusion criteria in VOSviewer. The nuanced themes captured included specific pathogens (e.g., hepatitis, tuberculosis) and molecular mechanisms (e.g., telomerase regulation) (35). The analysis revealed that HIV (26 occurrences), aging (23), telomere length (22), telomere (14), and COVID-19 (14) were the most frequently used keywords across publications. The dominant research focus has been on viral infections, immune aging, and telomere dynamics.

To examine the temporal evolution of research themes, an overlay visualization of keyword co-occurrence was generated using VOSviewer. This approach groups keywords according to their average year of publication, enabling the identification of emerging research hotspots and shifts in thematic emphasis over time. The colour gradient represents the average publication year, ranging from blue (earlier studies) to yellow (more recent studies), thereby illustrating the progression of research focus across distinct periods (Tomaszewski, 2023).

Although the bibliometric search strategy explicitly included bacterial, parasitic, and viral infections as primary search terms, analysis of the included publications revealed a strikingly uneven representation of infectious agents. As summarized in Table 5, viral pathogens dominated the literature, accounting for 110 of 123 studies (89.4%), with research almost exclusively focused on HIV-1, cytomegalovirus, hepatitis viruses, and SARS-CoV-2. In contrast, bacterial infections were represented by only 9 studies (7.3%), primarily involving Mycobacterium tuberculosis and selected periodontal pathogens, while parasitic infections were markedly underrepresented, with just 4 studies (3.3%) addressing Plasmodium falciparum malaria or parasitic coinfections.