Unveiling the underestimated prevalence of HIV, HBV and TB triple infection in Asia, South America, and Africa: a systematic review and meta-analysis.

BACKGROUND: Human immunodeficiency virus (HIV) is a genus of retroviruses that targets immune cells and may eventually cause immune-deficiency illness. Triple infection of HIV/hepatitis B virus (HBV) /tuberculosis (TB) leads to a worse prognosis than mono-infection. We aimed to unveil the pooled estimation of HIV/HBV/TB co-infection prevalence in Asia, South America, and Africa.

METHODS: A systematic literature search in PubMed, Embase, and the Cochrane Library was performed for studies of the prevalence of HIV/HBV/TB triple infection published from January 1, 1990, to March 31, 2024. The Freeman–Tukey random effects model was used to calculate the pooled prevalence.

RESULTS: We included 7 studies with in total 6401 participants and 259 triple infection cases. The pooled triple infection rate in the enrolled population was 4.4% (259/6401; 95% CI 2.2%-7.3%). The results of the subgroup analysis showed that the prevalence of triple infection was significantly higher in the South America (82/950, 8.6%; 95% CI 6.8%-10.4%), in men (86/1817, 3.4%; 95% CI 0.7%-7.8%) and patients receiving antiretroviral treatment (125/1611, 7.4%; 95% CI 5.8%–9.2%). However, no significant difference in the triple infection rate was observed among individuals initially diagnosed with HIV or TB.

CONCLUSIONS: This meta-analysis suggests that the prevalence of HIV/HBV/TB triple infection in the regions studied is underestimated, and we should focus more effort on improving novel strategies for identifying triple infection of HIV/HBV/TB. However, additional studies are required to be incorporated in future analyses to provide a pooled estimate of the global pooled prevalence.

CLINICAL TRIAL: Not applicable.

SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12879-025-12390-4.