Global seroprevalence of hepatitis E among people living with HIV: a systematic review and meta-analysis

Hepatitis E virus (HEV) infection can progress to chronic hepatitis in immunosuppressed individuals. The seroprevalence of hepatitis E among people living with human immunodeficiency virus (HIV) remains controversial. This systematic review and meta-analysis aimed to estimate the pooled global seroprevalence of hepatitis E among people living with HIV. This study followed the PRISMA guidelines and was registered in PROSPERO. Searches were conducted in PubMed, Embase, and Web of Science databases. The seroprevalence of hepatitis E (anti-HEV IgG) among people living with HIV was estimated by meta-analysis using the random-effects model. Subgroup meta-analyses were performed for each continent. A total of 88 studies from all continents were included, most originated from Europe (48.9%). The pooled seroprevalence of hepatitis E was 16.0% (95% CI: 13.0-18.0; I2 = 97.7%). Subgroup analyses revealed seroprevalence rates of 12.0% in Europe, 24.0% in Asia, 19.0% in Africa, and 11.0% in the Americas, and a notably high prevalence observed in low-income countries (37.0%). Sensitivity analyses restricted to studies with sample sizes >200 and risk of bias score ≥ 7 showed seroprevalence estimates of 18.0% and 15.0%, respectively. In conclusion, this meta-analysis demonstrates a pooled global seroprevalence of hepatitis E of 16.0% among people living with HIV, ranging from 11.0% to 24.0% across the continents.