Prevalence of TB/HIV Co-Infection in Countries Except China: A Systematic Review and Meta-Analysis

Background: TB and HIV co-epidemic is a major public health problem in many parts of the world. But the prevalence of TB/HIV co-infection was diversified among countries. Exploring the reasons of the diversity of TB/HIV co-infection is important for public policy, planning and development of collaborative TB/HIV activities. We aimed to summarize the prevalence of TB and HIV co-infection worldwide, using meta-analysis based on systematic review of published articles. Methods: We searched PubMed, Embase, and Web of Science for studies of the prevalence of TB/HIV co-infection. We also searched bibliographic indices, scanned reference lists, and corresponded with authors. We summarized the estimates using meta-analysis and explored potential sources of heterogeneity in the estimates by metaregression analysis. Results: We identified 47 eligible studies with a total population of 272,466. Estimates of TB/HIV co-infection prevalence ranged from 2.93% to 72.34%; the random effects pooled prevalence of TB/HIV co-infection was 23.51% 95% CI 20.91-26.11). We noted substantial heterogeneity Cochran's chi(2) = 10945.31, p<0.0001; I-2 = 99.58%, 95% CI 99.55-99.61). Prevalence of TB/HIV co-infection was 31.25% 95% CI 19.30-43.17) in African countries, 17.21% 95% CI 9.97-24.46) in Asian countries, 20.11% 95% CI 13.82-26.39) in European countries, 25.06% 95% CI 19.28-30.84) in Latin America countries and 14.84% 95% CI 10.44-19.24) in the USA. Prevalence of TB/HIV co-infection was higher in studies in which TB diagnosed by chest radiography and HIV diagnosis based on blood analyses than in those which used other diagnostic methods, and in countries with higher prevalence HIV in the general population than in countries with lower general prevalence. Conclusions: Our analyses suggest that it is necessary to attach importance to HIV/TB co-infection, especially screening of TB/HIV co-infection using methods with high sensitivity, specificity and predictive values in the countries with high HIV/AIDS prevalence in the general population.