Global and Regional Prevalence of Hepatitis C and B Co-Infections Among Prisoners Living with HIV: A Systematic Review and Meta-Analysis

Background: Worldwide, hepatitis B virus (HBV) and hepatitis C virus (HCV) infections are common among those living with HIV due to similar transmission routes and vulnerability. The global and regional burden of HBV and HCV infections among prisoners living with HIV have not systematically studied yet. Methods: Up to August 2019, we searched PubMed via MEDLINE, Embase, the Cochrane Library, SCOPUS and Web of science (ISI) to identify studies that reported the prevalence of HBV and HCV among prisoners living with HIV. We used an eight-item checklist for critically appraisal studies of prevalence/ incidence of a health problem to assess the quality of publications in the included 50 cross-sectional and 4 cohort studies. We used random-effect models and meta-regression for meta-analysis of the results. Findings: Included studies were 50 for HCV, 23 for HBV and 15 for HCV/HBV co-infection. The pooled prevalence was 9% (95% CI: 6·0-12·0) for HBV, 60% (95% CI: 51·0-69·0) for HCV, and 29% (95% CI: 18·0-40·0) for HCV/HBV co-infection among prisoners living with HIV. Among HIV-positive prisoners who reported drug injection, the HBV prevalence increased to 12% (95% CI: 3·0-21·0) and the HCV prevalence increased to 78% (95% CI: 51·0-100). The HBV prevalence ranged from 1% in East Mediterranean region to 81% in the America region. The HCV prevalence ranged from 6% in Europe to 98% in the East Mediterranean region. The highest HBV/HCV co-infection among prisoners living with HIV was 85% in Europe region. Meta-regression results showed small changes in HCV (0·05% increase per year), HBV (0·03% increase per year) and HCV/HBV co-infection (0·014% increase per year) prevalence over time among prisoners living with HIV. Interpretation: Our findings suggested a high prevalence of HBV and HCV co-infections among prisoners living with HIV particularly those with history of drug injection that varied significantly across different regions. Over decades we have seen no change in prevalence of such co-infections which call for better screening and treatment programs targeting prisoner living with HIV. Funding Statement: The study was funded by Shahroud University of Medical Sciences and Shiraz University of Medical Sciences. For this paper, we also received support from the University of California, San Francisco’s International Traineeships in AIDS Prevention Studies (ITAPS), U.S. NIMH, R25MH064712. Declaration of Interests: The authors have no competing interests to declare. Ethics Approval Statement: The study protocol was registered in the PROSPERO international under number of CRD42018115707.