1 Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK.
2 NIHR Health Protection Research Unit in Evaluation of Interventions, Population Health Sciences, Bristol Medical School, University of Bristol, UK.
3 Humanitarian Public Health Technical Unit, Save the Children UK, London, EC1M 4AR, UK.
4 UNAIDS, Geneva, Switzerland.
5 Centre for Disease Control and Prevention, Atlanta, USA.
6 Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, UK.
7 Department of Clinical Research, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
8 World Health Organisation, Geneva.
Globally, 35 million people are living with HIV (PLHIV) and 257 million have chronic HBV infection (HBsAg positive). The extent of HIV-HBsAg co-infection is unknown. We undertook a systematic review to estimate the global burden of HBsAg co-infection in PLHIV. We searched MEDLINE, EMBASE and other databases for published studies (2002-2018) measuring prevalence of HBsAg among PLHIV. The review was registered with PROSPERO (#CRD42019123388). Populations were categorised by HIV-exposure category. The global burden of co-infection was estimated by applying regional co-infection prevalence estimates to UNAIDS estimates of PLHIV. We conducted a meta-analysis to estimate the odds of HBsAg among PLHIV compared to HIV-negative individuals. We identified 506 estimates (475 studies) of HIV-HBsAg co-infection prevalence from 80/195 (41.0%) countries. Globally, the prevalence of HIV-HBsAg co-infection is 6.1% (IQR 4.0-9.9%) in PLHIV, or 2.6 million HIV-HBsAg co-infections (IQR 1.9-4.2). The greatest burden (69% of cases; 1.9 million) is in Sub-Saharan Africa. Globally there was little difference in prevalence of HIV-HBsAg co-infection by population group (approximately 6-7%), but slightly higher among PWID (11.8% IQR 6. 0-16.9%). Odds of HBsAg infection is 1.4 times higher among PLHIV compared to HIV-negative individuals. There is therefore, a high global burden of HIV-HBsAg co-infection, especially in Sub-Saharan Africa. Findings highlight the importance of specific targeting PLHIV for testing, catch-up HBV vaccination and other preventative interventions. The global scale-up of HIV treatment for PLHIV using a tenofovir-based ART regimen provides an opportunity to simultaneously treat those with HBsAg co-infection and reduce mother-to-child transmission of HBV alongside HIV.