Published online Nov 8, 2015. doi: 10.4254/wjh.v7.i25.2619
Peer-review started: June 25, 2015
First decision: August 26, 2015
Revised: September 26, 2015
Accepted: October 23, 2015
Article in press: October 27, 2015
Published online: November 8, 2015
AIM: To identify gaps in the existing knowledge on single, dual and triple infections of human immunodeficiency virus (HIV), hepatitis B virus (HBV) and hepatitis C virus (HCV) in the Middle East and North Africa (MENA) region among men who have sex with men (MSMs), female sex workers (FSWs), injecting drug users (IDUs) and prisoners.
METHODS: We performed an extensive literature search on articles published on the topic in the 25 countries of the MENA region. PubMed database was used as the main search engine. Case reports, case series, qualitative studies, editorials, commentaries, authors’ replies and animal studies were excluded. Original articles and reviews dealing with the prevalence of HIV, HBV and HCV and their co-infection were included. Data on population type, sample size, age and markers of infections were extracted from the relevant studies.
RESULTS: HIV, HBV and HCV are blood-borne viruses with similar modes of transmission. The categories of people at high risk of acquiring HIV-1, HBV and HCV commonly include: MSMs, FSW and IDUs. It is well established that HIV-positive individuals co-infected with HBV or HCV suffer from liver pathology associated with morbidity and mortality. Moreover, HIV-infected individuals do not respond well to treatment for HBV or HCV and hence are at increased risk of hepatic toxicity. Consequently, co-infection of HIV-positive individuals with HBV and/or HCV is a global health problem of significant magnitude. Our review reveals the paucity of epidemiological data for key populations in many countries of the region. Limited number of studies exists in the MENA region on the status of HIV, HBV and HCV and their co-infections among prisoners, MSMs and FSWs. Evidence support the continued increase of the HIV epidemic among MSMs. In addition to the lack of studies on MSMs and FSWs in the MENA region, our review highlights the lack of data on the practices, characteristics, or the status of HIV infection and viral hepatitis among male sex workers selling or exchanging sex for money.
CONCLUSION: The MENA countries are in urgent need of advanced research and strengthening of the data collection systems and reporting practices of these infections among key populations.
Core tip: Despite the availability of preventive and control measures, co-infection of human immunodeficiency virus (HIV)-positive individuals with hepatitis B virus (HBV) and/or hepatitis C virus (HCV) is a global health problem of significant and increasing magnitude. While the potential of worse HIV outcomes are suggested to be associated with viral hepatitis, it is still yet to identify the populations in the Middle East and North Africa (MENA) region with dual infections (HIV-HBV or HIV-HCV) or triple co-infections with HIV, HBV and HCV. This review highlights the available data on HIV, HBV and HCV and their co-infections in the MENA countries with specific focus on high-risk groups (men who have sex with men, female sex workers, injecting drug users and prisoners).