Underestimated prevalence of HIV, hepatitis B virus (HBV), and hepatitis D virus (HDV) triple infection globally: Systematic review and meta-analysis


BACKGROUND: Hepatitis delta virus (HDV) is a satellite RNA virus that relies on hepatitis B virus (HBV) for transmission. HIV/HBV/HDV coinfection or triple infection is common and has a worse prognosis than monoinfection. OBJECTIVE: We aimed to reveal the epidemiological characteristics of HIV/HBV/HDV triple infection in the global population. METHODS: A systematic literature search in PubMed, Embase, and the Cochrane Library was performed for studies of the prevalence of HIV/HBV/HDV triple infection published from January 1, 1990, to May 31, 2021. The Der Simonian-Laird random effects model was used to calculate the pooled prevalence. RESULTS: We included 14 studies with 11,852 participants. The pooled triple infection rate in the global population was 7.4% (877/11,852; 95% CI 0.73%–29.59%). The results of the subgroup analysis showed that the prevalence of triple infection was significantly higher in the Asian population (214/986, 21.4%; 95% CI 7.1%–35.8%), in men (212/5579, 3.8%; 95% CI 2.5%–5.2%), and in men who have sex with men (216/2734, 7.9%; 95% CI 4.3%–11.4%). In addition, compared with people living with HIV, the HIV/HBV/HDV triple infection rate was higher in people with hepatitis B. CONCLUSIONS: This meta-analysis suggests that the prevalence of HIV/HBV/HDV triple infection in the global population is underestimated, and we should focus more effort on the prevention and control of HIV/HBV/HDV triple infection.


Chen S, Ren F, Huang X, Xu L, Gao Y, Zhang X, Cao Y, Fan Z, Tian Y, Liu M




  • Epidemiology and Determinants of Health
    • Epidemiology
  • Population(s)
    • General HIV+ population
  • Co-infections
    • Hepatitis B, C
    • Other


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