title: Hepatitis B/C and HIV in sub-Saharan Africa: an association between highly prevalent infectious diseases. A systematic review and meta-analysis.
abstract: OBJECTIVE
  Hepatitis B virus (HBV), hepatitis C virus (HCV), and the human immunodeficiency virus (HIV) are endemic in Africa. However, hepatitis co-infection rates among HIV-infected individuals remain controversial. The aim of this review was to determine the prevalence of HBV and HCV in HIV-infected patients in sub-Saharan Africa and to analyze whether HIV is associated with a higher HBV/HCV prevalence in that region.
  
  
  METHODS
  We performed a systematic review and meta-analysis. Studies reporting HBV and HCV prevalence data amongst HIV-infected patients in sub-Saharan Africa were included. Weighted means and medians across studies were calculated. Studies including an HIV-negative control group were used for meta-analysis. Risk ratios (RRs) were calculated using a random effects model.
  
  
  RESULTS
  Sixty studies were included. Among HIV-infected individuals, mean HBsAg and anti-HCV prevalence rates were 15% and 7%, respectively. RRs for a positive HBsAg and a positive anti-HCV were 1.40 (95% confidence interval (CI) 1.16-1.69) and 1.60 (95% CI 1.05-2.45) for HIV-infected, as compared to HIV-uninfected, patients.
  
  
  CONCLUSIONS
  Many HIV-positive individuals in sub-Saharan Africa are HBV or HCV co-infected. HIV is associated with a higher prevalence of both HBV and HCV in this region. However, this association is less evident than that observed in Western countries and varies between studies.
authors.affiliation: Department of Internal Medicine and Infectious Diseases, University Medical Centre Utrecht, F02.126, Postbus 85500, 3508 GA Utrecht, the Netherlands. r.e.barth@umcutrecht.nl
authors.forename: Roos E
authors.initials: RE
authors.lastname: Barth
authors.forename: Quirine
authors.initials: Q
authors.lastname: Huijgen
authors.forename: Jantjie
authors.initials: J
authors.lastname: Taljaard
authors.forename: Andy I M
authors.initials: AI
authors.lastname: Hoepelman
mesh_terms: D017954:Africa South of the Sahara / Q000453:epidemiology; D015658:HIV Infections / Q000150:complications* / Q000453:epidemiology* / Q000821:virology; D015497:HIV-1; D016174:Hepacivirus / Q000302:isolation & purification; D006509:Hepatitis B / Q000150:complications* / Q000453:epidemiology* / Q000821:virology; D006515:Hepatitis B virus / Q000302:isolation & purification; D006526:Hepatitis C / Q000150:complications* / Q000453:epidemiology* / Q000821:virology; D006801:Humans; D015995:Prevalence