Prevalence of and risk factors forPlasmodiumspp. co-infection with hepatitis B virus: a systematic review and meta-analysis

Background Plasmodiumspp. and hepatitis B virus (HBV) are among the most common infectious diseases in underdeveloped countries. This study aimed to determine the prevalence ofPlasmodiumspp. and HBV co-infection in people living in endemic areas of both diseases and to assess the risk factors related to this co-infection. Methods The PubMed, Web of Science, and Scopus databases were searched. Observational cross-sectional studies and retrospective studies assessing the prevalence ofPlasmodiumspecies and HBV co-infection were examined. The methodological quality of the included studies was assessed with the Newcastle-Ottawa Scale (NOS), a tool for assessing the quality of nonrandomized studies in meta-analyses, and heterogeneity among the included studies was assessed with Cochran's Qtest and the I-2(inconsistency) statistic. The pooled prevalence of the co-infection and its 95% confidence interval (CI) were estimated using the random-effects model, depending on the amount of heterogeneity there was among the included studies. The pooled odds ratio (OR) represented the difference in qualitative variables, whereas the pooled mean difference (MD) represented the difference in quantitative variables. Meta-analyses of the potential risk factors forPlasmodiumspp. and HBV co-infection, including patient age and gender, were identified and represented as pooled odds ratios (OR) and 95% CIs. Publication bias among the included studies was assessed by visual inspection of a funnel plot to search for asymmetry. Results Twenty-two studies were included in the present systematic review and meta-analysis. Overall, the pooled prevalence estimate ofPlasmodiumspp. and HBV co-infection was 6% (95% CI 4-7%, Cochran's Qstatistic < 0.001, I-2: 95.8%), with prevalences of 10% in Gambia (95% CI: 8-12%, weight: 4.95%), 8% in Italy (95% CI 5-12%, weight: 3.8%), 7% in Nigeria (95% CI 4-10%, weight: 53.5%), and 4% in Brazil (95% CI 2-5%, weight: 19.9%). The pooled prevalence estimate ofPlasmodiumspp. and HBV co-infection was higher in studies published before 2015 (7%, 95% CI 4-9%, Cochran's Qstatistic < 0.001, I-2: 96%) than in those published since 2015 (3%, 95% CI 1-5%, Cochran's Qstatistic < 0.001, I-2: 81.3%). No difference in age and risk ofPlasmodiumspp. and HBV co-infection group was found between thePlasmodiumspp. and HBV co-infection and thePlasmodiummonoinfection group (p: 0.48, OR: 1.33, 95% CI 0.60-2.96). No difference in gender and risk ofPlasmodiumspp. and HBV co-infection group was found between thePlasmodiumspp. and HBV co-infection and HBV co-infection group and thePlasmodiummonoinfection group (p: 0.09, OR: 2.79, 95% CI 0.86-9.10). No differences in mean aspartate aminotransferase (AST), mean alanine aminotransferase (ALT), or mean total bilirubin levels were found (p > 0.05) between thePlasmodiumspp. and HBV co-infection group and thePlasmodiummonoinfection group. Conclusions The present study revealed the prevalence ofPlasmodiumspp. and HBV co-infection, which will help in understanding co-infection and designing treatment strategies. Future studies assessing the interaction betweenPlasmodiumspp. and HBV are recommended.