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Clin Infect Dis. 2019 Dec 9. pii: ciz1170. doi: 10.1093/cid/ciz1170. [Epub ahead of print]

Global burden of hepatitis B infection in people living with HIV: a systematic review and meta-analysis.

Author information

The Biotechnology Centre, University of Yaoundé I, Yaoundé, Cameroon.
School of Public Health, University of Paris-Saclay, Paris, France.
Department of Biochemistry, Faculty of Sciences, University of Yaoundé I, Yaoundé, Cameroon.
Department of Virology, Centre Pasteur of Cameroon, Yaoundé, Cameroon.
Department of Internal Medicine, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon.
Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa.



This systematic review and meta-analysis was conducted to estimate the prevalence and burden of HBV infection in PLWH at global, regional, and national levels.


We searched of PubMed, Excerpta Medica Database, Web of Science, and Global Index Medicus to identify studies published between January 01, 1990 and December 31st, 2017. HBV infection (HBs antigen) had to be diagnosed with serological assays. Random-effect models meta-analysis served to pool data.


We included 358 studies (834,544 PLWH from 87 countries). The pooled prevalence of HBV infection was 8.4% (95% confidence interval: 7.9-8.8); among which 26.8% (22.0-31.9) were positive to HBe antigen. The HBV prevalence was different according to UNAIDS regions: West & Central Africa: 12.4% (11.0-13.8), Middle East & North Africa: 9.9% (6.0-14.6), Asia & the Pacific: 9.8% (8.7-11.0), Eastern & Southern Africa: 7.4% (6.4-8.4), Western and Central Europe & North America: 6.0% (5.5-6.7), and Latin America & the Caribbean: 5.1% (4.2-6.2); p < 0.0001. The prevalence decreased from 10.4% in low to 6.6% in very high developed countries; p < 0.0001 and increased from 7.3% in countries with HIV prevalence ≤ 1% to 9.7% in countries with HIV prevalence > 1%; p < 0.0001. Globally, we estimated that there were roughly 3,136,500 (95%CI: 2,95,2000-3,284,100) cases of HBV in PLWH; with 73.8% of estimated regional cases from sub-Saharan Africa and 17.1% from Asia & the Pacific.


This study suggests a high burden of HBV infection in PLWH, with disparities according to regions, level of development, and country HIV prevalence.


AIDS; HIV; global burden; hepatitis B


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