非洲人类免疫缺陷病毒感染者中乙型肝炎病毒和/或丙型肝炎病毒感染的流行病学：系统评价和荟萃分析。

Epidemiology of hepatitis B virus and/or hepatitis C virus infections among people living with human immunodeficiency virus in Africa: A systematic review and meta-analysis.

机构信息

Department of Biochemistry, The University of Yaounde I, Yaounde, Cameroon.

Department of Microbiology and Parasitology, University of Buea, Buea, Cameroon.

出版信息

PLoS One. 2022 May 31;17(5):e0269250. doi: 10.1371/journal.pone.0269250. eCollection 2022.

INTRODUCTION

Due to their common routes of transmission, human immunodeficiency virus (HIV) coinfection with hepatitis B virus (HBV) and/or hepatitis C virus (HCV) has become a major public health problem worldwide, particularly in Africa, where these viruses are endemic. Few systematic reviews report the epidemiological data of HBV and/or HCV coinfection with HIV in Africa, and none provided data on the case fatality rate (CFR) associated with this coinfection. This study was conducted to investigate the prevalence and case fatality rate of HBV and/or HCV infections among people living with human immunodeficiency virus (PLHIV) in Africa.

METHODS

We conducted a systematic review of published articles in PubMed, Web of Science, African Journal Online, and African Index Medicus up to January 2022. Manual searches of references from retrieved articles and grey literature were also performed. The meta-analysis was performed using a random-effects model. Sources of heterogeneity were investigated using subgroup analysis, while funnel plots and Egger tests were performed to assess publication bias.

RESULTS

Of the 4388 articles retrieved from the databases, 314 studies met all the inclusion criteria. The overall HBV case fatality rate estimate was 4.4% (95% CI; 0.7-10.3). The overall seroprevalences of HBV infection, HCV infection, and HBV/HCV coinfection in PLHIV were 10.5% [95% CI = 9.6-11.3], 5.4% [95% CI = 4.6-6.2], and 0.7% [95% CI = 0.3-1.0], respectively. The pooled seroprevalences of current HBsAg, current HBeAg, and acute HBV infection among PLHIV were 10.7% [95% CI = 9.8-11.6], 7.0% [95% CI = 4.7-9.7], and 3.6% [95% CI = 0.0-11.0], respectively. Based on HBV-DNA and HCV-RNA detection, the seroprevalences of HBV and HCV infection in PLHIV were 17.1% [95% CI = 11.5-23.7] and 2.5% [95% CI = 0.9-4.6], respectively. Subgroup analysis showed substantial heterogeneity.

CONCLUSIONS

In Africa, the prevalence of hepatotropic viruses, particularly HBV and HCV, is high in PLHIV, which increases the case fatality rate. African public health programs should emphasize the need to apply and comply with WHO guidelines on viral hepatitis screening and treatment in HIV-coinfected patients.

REVIEW REGISTRATION

PROSPERO, CRD42021237795.

简介

由于它们共同的传播途径，人类免疫缺陷病毒（HIV）与乙型肝炎病毒（HBV）和/或丙型肝炎病毒（HCV）的合并感染已成为全球范围内的一个主要公共卫生问题，特别是在这些病毒流行的非洲地区。少数系统评价报告了非洲 HIV 合并感染 HBV 和/或 HCV 的流行病学数据，并且没有提供与这种合并感染相关的病死率（CFR）数据。本研究旨在调查非洲 HIV 感染者（PLHIV）中 HBV 和/或 HCV 合并感染的流行率和病死率。

方法

我们对截至 2022 年 1 月在 PubMed、Web of Science、African Journal Online 和 African Index Medicus 上发表的文章进行了系统综述。还对检索到的文章和灰色文献的参考文献进行了手工搜索。使用随机效应模型进行荟萃分析。使用亚组分析研究异质性的来源，同时使用漏斗图和 Egger 检验评估发表偏倚。

结果

从数据库中检索到的 4388 篇文章中，有 314 篇符合所有纳入标准。HBV 总病死率估计值为 4.4%（95%CI；0.7-10.3）。PLHIV 中 HBV 感染、HCV 感染和 HBV/HCV 合并感染的总血清流行率分别为 10.5%[95%CI=9.6-11.3]、5.4%[95%CI=4.6-6.2]和 0.7%[95%CI=0.3-1.0]。PLHIV 中当前 HBsAg、当前 HBeAg 和急性 HBV 感染的合并血清流行率分别为 10.7%[95%CI=9.8-11.6]、7.0%[95%CI=4.7-9.7]和 3.6%[95%CI=0.0-11.0]。基于 HBV-DNA 和 HCV-RNA 检测，PLHIV 中 HBV 和 HCV 感染的血清流行率分别为 17.1%[95%CI=11.5-23.7]和 2.5%[95%CI=0.9-4.6]。亚组分析显示存在很大的异质性。