Global Burden of Hepatitis B Infection in People Living With Human Immunodeficiency Virus: A Systematic Review and Meta-analysis

Abstract Background This meta-analysis was conducted to estimate the global burden of hepatitis B virus (HBV) infection in people living with human immunodeficiency virus (PLWH). Methods We searched multiple databases for studies published between January 1990 and December 2017. HBV infection (hepatitis B surface antigen) was diagnosed with serological assays. A random-effects meta-analysis served to pool data. Results We included 358 studies (834 544 PLWH from 87 countries). The pooled prevalence of HBV infection was 8.4% (95% confidence interval [CI], 7.9%–8.8%), among which 26.8% (95% CI, 22.0%–31.9%) was positive to hepatitis B e antigen. HBV prevalence (with 95% CIs) differed according to region: West and Central Africa, 12.4% (11.0%–13.8%); Middle East and North Africa, 9.9% (6.0%–14.6%); Asia and the Pacific, 9.8% (8.7%–11.0%); Eastern and Southern Africa, 7.4% (6.4%–8.4%); Western and Central Europe and North America, 6.0% (5.5%–6.7%); and Latin America and the Caribbean, 5.1% (4.2%–6.2%) (P < .0001). The prevalence decreased from 10.4% in low-developed to 6.6% in highly developed countries (P < .0001) and increased from 7.3% in countries with HIV prevalence ≤1% to 9.7% in countries with HIV prevalence >1% (P < .0001). Globally, we estimated that there were 3 136 500 (95% CI, 2 952 000–3 284 100) cases of HBV in PLWH, with 73.8% of estimated regional cases from sub-Saharan Africa and 17.1% from Asia and the Pacific. Conclusions This study suggests a high burden of HBV infection in PLWH, with disparities according to region, level of development, and country HIV prevalence. In this meta-analysis of 834 544 HIV-infected people from 87 countries, the global prevalence of hepatitis B infection is high (8.4%), with substantial heterogeneity by UNAIDS region. The burden is higher in sub-Saharan Africa, followed by Asia and the Pacific.