Hepatitis C in HIV‐infected individuals: a systematic review and meta‐analysis of estimated prevalence in Africa

Abstract

Introduction 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. Methods 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. Results 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. Conclusions 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.

Keywords

• HIV infection
• hepatitis C infection
• Africa
• meta‐analysis
• antibody test
• polymerase chain reaction