Prevalence and burden of HBV co‐infection among people living with HIV: A global systematic review and meta‐analysis

Abstract

Globally, in 2017 35 million people were living with HIV (PLHIV) and 257 million had chronic HBV infection (HBsAg positive). The extent of HIV‐HBsAg co‐infection is unknown. We undertook a systematic review to estimate the global burden of HBsAg co‐infection in PLHIV. We searched MEDLINE, Embase and other databases for published studies (2002‐2018) measuring prevalence of HBsAg among PLHIV. The review was registered with PROSPERO (#CRD42019123388). Populations were categorized by HIV‐exposure category. The global burden of co‐infection was estimated by applying regional co‐infection prevalence estimates to UNAIDS estimates of PLHIV. We conducted a meta‐analysis to estimate the odds of HBsAg among PLHIV compared to HIV‐negative individuals. We identified 506 estimates (475 studies) of HIV‐HBsAg co‐infection prevalence from 80/195 (41.0%) countries. Globally, the prevalence of HIV‐HBsAg co‐infection is 7.6% (IQR 5.6%‐12.1%) in PLHIV, or 2.7 million HIV‐HBsAg co‐infections (IQR 2.0‐4.2). The greatest burden (69% of cases; 1.9 million) is in sub‐Saharan Africa. Globally, there was little difference in prevalence of HIV‐HBsAg co‐infection by population group (approximately 6%‐7%), but it was slightly higher among people who inject drugs (11.8% IQR 6.0%‐16.9%). Odds of HBsAg infection were 1.4 times higher among PLHIV compared to HIV‐negative individuals. There is therefore, a high global burden of HIV‐HBsAg co‐infection, especially in sub‐Saharan Africa. Key prevention strategies include infant HBV vaccination, including a timely birth‐dose. Findings also highlight the importance of targeting PLHIV, especially high‐risk groups for testing, catch‐up HBV vaccination and other preventative interventions. The global scale‐up of antiretroviral therapy (ART) for PLHIV using a tenofovir‐based ART regimen provides an opportunity to simultaneously treat those with HBV co‐infection, and in pregnant women to also reduce mother‐to‐child transmission of HBV alongside HIV.

Low rates of active hepatitis B and C infections among adults and children living with HIV and taking antiretroviral therapy: A multicenter screening study in Lesotho

“…A recent meta-analysis noted a co-seroprevalence of 4.4% for the Southern African region. 2 Earlier studies found that patients with HBV coinfection are at a higher risk to develop liver fibrosis and cirrhosis. 4,13 Although the diagnostic accuracy of APRI is inferior to an ultrasound-guided assessment of liver elasticity (fibroscan) or liver biopsy, the WHO recommends APRI for the clinical management of HBV.…”

“…1 Persons living with the human immunodeficiency virus (HIV) are a key population most affected by HBV and HCV infection. 2,3 Coinfection with HIV has been identified as an additional factor for fibrosis progression and liver carcinogenesis. 4 The estimated global prevalence of HIV/HBV coinfection is 7.6%, leading to 2.7 million individuals simultaneously carrying HIV and HBV.…”

“…The highest numbers are found in sub-Saharan Africa (69% of all cases; 1.9 million). 2 For HIV and HCV, global coprevalence is 2.4% 3 and a recent systematic review shows a coprevalence of 4.6% in southeast Africa. 5 Published prevalence data for HBV and HCV in Lesotho, a small country in Southern Africa with the second-highest HIV prevalence globally, 6 are limited.…”

Chronic Hepatitis B and HIV Coinfection: a Continuing Challenge in the Era of Antiretroviral Therapy

“…HBV incidence has also been shown to be moderately high in HBV-endemic settings among PLWH with relatively preserved CD4 cell counts [44]. HBV burden is also higher among marginalized populations such as those who inject drugs or are imprisoned, who are also at greater risk of HIV [2,45]. Unfortunately, despite recommendations to immunize all susceptible persons with HIV against hepatitis B, one study conducted by the US Centers for Disease Control of over 18,000 patients in HIV care from 2009 to 2012 found that 44.2% had no documentation of HBV vaccination, immunity or infection in the medical record [46•].…”

Hepatitis B virus infection among men who have sex with men and transgender women living with or at risk for HIV: A cross sectional study in Abuja and Lagos, Nigeria.

“…Despite the development of a safe and efficacious hepatitis B vaccine in 1982 [1], the hepatitis B virus (HBV) remains a public health burden in sub-Saharan Africa with a reported prevalence of about 6% [2,3]. While mortality in sub-Saharan Africa from the World Health Organization (WHO)-targeted infectious diseases (i.e.…”