Efficacy and safety of TDF+3TC + EFV‑centric antiretroviral regimens for HIV/HBV co-infection: a systematic review and network meta‑analysis

To evaluate the efficacy and safety of antiretroviral therapy(ART) regimens based on tenofovir(TDF) + lamivudine(3TC) + efavirenz(EFV) in patients co-infected with Human Immunodeficiency Virus (HIV) and Hepatitis B Virus (HBV), thereby providing evidence-based support for clinical treatment decision-making. Relevant studies published from database inception to March 2025 were systematically retrieved from the CNKI, Wanfang, VIP, SinoMed, PubMed, Embase, Web of Science, and Cochrane Library databases. The revised Risk of Bias tool version 2 (ROB2) was used to assess study quality, and all meta-analyses were performed using Stata 18 software. A total of 31 randomized controlled trials (RCTs) involving 2124 participants and 12 treatment interventions were included, with four outcome measures evaluated. The network meta-analysis demonstrated that the TDF + 3TC + EFV triple therapy regimen was superior to the other evaluated regimens in achieving higher HBV DNA and HIV RNA negative conversion rates. In addition, TDF+ 3TC + EFV demonstrated greater efficacy than zidovudine(AZT) + 3TC + EFV in increasing CD4 + lymphocyte counts. The surface under the cumulative ranking curve (SUCRA) analysis indicated that TDF + 3TC + EFV ranked highest in terms of efficacy. Regarding safety, several studies reported various types of adverse events. However, no statistically significant differences were observed among the treatment groups. Based on the currently available evidence, this network meta-analysis suggests that the TDF + 3TC + EFV triple regimen demonstrates superior efficacy across multiple outcome measures in patients with HIV/HBV co-infection. Nevertheless, owing to the inherent limitations of the included studies, further high-quality studies are required to confirm its role as a preferred therapeutic option.