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

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.