Hepatitis C in HIV-infected individuals: a systematic review and meta-analysis of estimated prevalence in Africa.
Although hepatitis C virus (HCV) screening is recommended for all HIV-infected patients initiating antiretroviral therapy, data on epidemiologic characteristics of HCV infection in resource-limited settings are scarce.



We searched PubMed and EMBASE for studies assessing the prevalence of HCV infection among HIV-infected individuals in Africa and extracted data on laboratory methods used. Prevalence estimates from individual studies were combined for each country using random-effects meta-analysis. The importance of study design, population and setting as well as type of test (anti-HCV antibody tests and polymerase chain reactions) was examined with meta-regression.



Three randomized controlled trials, 28 cohort studies and 121 cross-sectional analyses with 108,180 HIV-infected individuals from 35 countries were included. The majority of data came from outpatient populations (55%), followed by blood donors (15%) and pregnant women (14%). Based on estimates from 159 study populations, anti-HCV positivity prevalence ranged between 3.3% (95% confidence interval (CI) 1.8-4.7) in Southern Africa and 42.3% (95% CI 4.1-80.5) in North Africa. Study design, type of setting and age distribution did not influence this prevalence significantly. The prevalence of replicating HCV infection, estimated from data of 29 cohorts, was 2.0% (95% CI 1.5-2.6). Ten studies from nine countries reported the HCV genotype of 74 samples, 53% were genotype 1, 24% genotype 2, 14% genotype 4 and 9% genotypes 3, 5 or 6.



The prevalence of anti-HCV antibodies is high in HIV-infected patients in Africa, but replicating HCV infection is rare and varies widely across countries.
Department of Infectious Diseases, Bern University Hospital, University of Bern, Switzerland.
Tiago Castro Lopes
TC
Azevedo
Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland.
Marcel
M
Zwahlen
Department of Infectious Diseases, Bern University Hospital, University of Bern, Switzerland.
Andri
A
Rauch
Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland.|Centre for Infectious Disease Epidemiology and Research (CIDER), University of Cape Town, South Africa.
Matthias
M
Egger
Department of Infectious Diseases, Bern University Hospital, University of Bern, Switzerland.|Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland.|Department of Infectious Diseases, University of Dakar, Dakar, Senegal; gilles.wandeler@ispm.unibe.ch.
Gilles
G
Wandeler
D000349:Africa / Q000453:epidemiology; D015658:HIV Infections / Q000150:complications / Q000453:epidemiology*; D006526:Hepatitis C / Q000150:complications / Q000453:epidemiology*; D006801:Humans; D015995:Prevalence
Africa; HIV infection; antibody test; genotype; hepatitis C infection; meta-analysis; polymerase chain reaction