Estimating Hepatitis B Virus Burden Among HIV Populations

There is a high burden of hepatitis B virus infection among people living with HIV, according to a report published in Clinical Infectious Diseases.

An international team of investigators searched the existing literature in order to estimate the prevalence of hepatitis B virus in the general HIV population, as well as among specific or high-risk groups such as pregnant women, sex workers, men who have sex with men (MSM), transgender individuals, injection drug users, and incarcerated individuals. The investigators mined through PubMed, Excerpta Medica Database, Web of Science, and Global Index Medicus for records published between 1990 and 2017.

Initially, they ended up with 7502 records that they further refined to 354 full texts for their meta-analysis. The records included information on more than 800,000 patients living with HIV that were recruited between 1984 and 2016 and ranged in age from 2 to 93 years, the study authors said. Most of the study participants were from African regions (87 total countries) and single center.

The study authors wrote that because of the World Health Organization’s (WHO) and Joint United Nationals Programme for HIV/AIDS’ (UNAIDS) targeted goals of reducing new hepatitis cases accurate data on the burden of this disease are important. With correct data, officials can accurately plan and allocate resources to implement efficient strategies, the study authors wrote.

The global prevalence of hepatitis B virus infectivity among people living with HIV was 8.4%, the investigators learned. The global prevalence of hepatitis B among people living with HIV and infected with hepatitis B was 26.8%, the study authors added. However, 3 groups demonstrated higher prevalence—including sex workers (17.9%), injection drug users (14.1%), and men who have sex with men (12.4%)—compared to others, such as prisoners (6.0%), pregnant women (5.5%), and transgender individuals (3.2%).

The prevalence varied from 12.4% in regions such as West and Central Africa to 5.1% in Latin America and the Caribbean, the study authors determined, noting they were UNAIDS regions. WHO regions varied from 11.4% in Western Pacific areas to 5.1% in the Americas. The investigators did not find a difference in prevalence between age groups and periods, they said.

On the basis of their research, the study authors estimate there were roughly 3.1 million hepatitis B virus infections in people living with HIV, they wrote. Considering regional estimates, they explained, 90.9% of the cases were from Eastern and Southern Africa, Western and Central Africa, and Asia and the Pacific. Overall, 73.8% of cases were from sub-Saharan Africa (both Eastern/Southern Africa and Western/Central Africa), the investigators added.

“This study suggests a high burden of hepatitis B virus infection and infectivity in people living with HIV, with disparities according to regions, level of development, and country HIV prevalence. The prevalence was higher in HIV-infected key populations and lower in pregnant women,” the study authors wrote, adding that a previous report found a global prevalence of 7.4%, but the investigators said it could be explained by a difference in methodology.

“To curb the global burden of hepatitis B virus infection, innovative and community-based strategies are needed in people living with HIV including education, vaccine, hepatitis B virus testing, and initiation of appropriate treatment like anti-retroviral therapy containing tenofivir. Specific strategies are needed in sub-Saharan Africa and Asia, and the Pacific regions, especially in developing countries and countries with high HIV prevalence,” they wrote.