Prevalence of occult hepatitis B among HIV-positive individuals in Africa: A systematic review and meta-analysis

Abstract

The prevalence of hepatitis B virus among HIV-seropositive individuals is believed to be high, and yet the disease remains neglected in many areas of the continent. Little is known about occult hepatitis in HIV individuals. This review assessed occult hepatitis B infection and its prevalence in the different regions of the African continent. It also determines its prevalence in the HIV population which is endemic in the region. Studies were searched from the Cochrane, google scholar, PubMed/Medline, and African Journals online. Authors included cross-sectional studies, case controls, and cohorts, from 2010 to January 2021, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and Participants, Interventions, Comparisons, Outcomes, and Study design frameworks to develop the search strategy. All studies had participants who were HIV-positive, covering different regions of the continent. Risk ratio was used to measure effect size, and Stata 14 software was used for analysis. Eleven studies met the eligibility criteria, with 2567 participants. Overall prevalence of occult hepatitis B was 11.2%. Regional prevalence was 26.5% for the south, 11% for the north, 9.1% for the east, and 8.5% for the western region. Approximately 10% of HIV-seropositive individuals were co-infected with occult hepatitis B virus. Regionally, the prevalence was highest in the southern region and lowest in the west. The prevalence of occult HBV infection was compared between the southern region and the other regions. It was higher in the south compared to the east (risk ratio = 0.87, 95% confidence interval (0.83–0.91)). It was also higher in the south compared to the north (risk ratio = 0.82, 95% confidence interval (0.79–0.85)), and it was also higher in the south compared to the west (risk ratio = 0.85, 95% confidence interval (0.82–0.87)). Public health measures and interventions are required to raise awareness, increase prevention, and reduce spread of the disease. More evidence-based studies need to be carried out.

Prevalence of occult hepatitis B infection among treatment-naive persons living with HIV in Ghana

“…in their study, PLHIV were on treatment for HBV [29] Similarly, a study by Dzudzor et. al., among chronic kidney patients on hemodialysis in Ghana in 2024 who were HBeAg negative but HBcAb positive, found 7.3% had detectable HBV DNA [30] The OBI prevalence found in this study was relatively lower compared to a study in South Africa (19.1%) [31][32][33], and significantly lower than another study among PLHIV in Morocco (68.4%) [34]. Nonetheless, a relatively lower prevalence has been reported elsewhere.…”

“…Nonetheless, a relatively lower prevalence has been reported elsewhere. The overall burden of OBI in Africa is 11.2% [33] and in West Africa, OBI prevalence varies from 15% in Ivory Coast [35] to 6.9% in Cameroon [36] among PLHIV. The difference in prevalence of OBI could be attributed to factors such as the endemicity of HBV in a particular country, HIV prevalence and very importantly, HBV screening protocols.…”

Hepatitis B virus genotypes and drug resistance mutations circulating in blood donors in Beira, Mozambique

“…In our study of HBsAg-negative blood donors, 0.98% had occult HBV infection [ 35 ]. Occult HBV has been reported in other African countries with a regional prevalence of 26.5% in the South, 11% in the North, 9.1% in the East, and 8.5% in the West [ 44 ]. To our knowledge, HBV drug resistance has been evaluated in Mozambique in two studies.…”