Global Burden of Hepatitis B Infection in People Living With Human Immunodeficiency Virus: A Systematic Review and Meta-analysis.

BACKGROUND: This meta-analysis was conducted to estimate the global burden of hepatitis B virus (HBV) infection in people living with human immunodeficiency virus (PLWH). METHODS: We searched multiple databases for studies published between January 1990 and December 2017. HBV infection (hepatitis B surface antigen) was diagnosed with serological assays. A random-effects meta-analysis served to pool data. RESULTS: We included 358 studies (834 544 PLWH from 87 countries). The pooled prevalence of HBV infection was 8.4% (95% confidence interval [CI], 7.9%-8.8%), among which 26.8% (95% CI, 22.0%-31.9%) was positive to hepatitis B e antigen. HBV prevalence (with 95% CIs) differed according to region: West and Central Africa, 12.4% (11.0%-13.8%); Middle East and North Africa, 9.9% (6.0%-14.6%); Asia and the Pacific, 9.8% (8.7%-11.0%); Eastern and Southern Africa, 7.4% (6.4%-8.4%); Western and Central Europe and North America, 6.0% (5.5%-6.7%); and Latin America and the Caribbean, 5.1% (4.2%-6.2%) (P < .0001). The prevalence decreased from 10.4% in low-developed to 6.6% in highly developed countries (P < .0001) and increased from 7.3% in countries with HIV prevalence ≤1% to 9.7% in countries with HIV prevalence >1% (P < .0001). Globally, we estimated that there were 3 136 500 (95% CI, 2 952 000-3 284 100) cases of HBV in PLWH, with 73.8% of estimated regional cases from sub-Saharan Africa and 17.1% from Asia and the Pacific. CONCLUSIONS: This study suggests a high burden of HBV infection in PLWH, with disparities according to region, level of development, and country HIV prevalence.

Global, regional, and country estimates of metabolic syndrome burden in children and adolescents in 2020: a systematic review and modelling analysis.

BACKGROUND: Halting the rise in cardiometabolic risk factors in children and adolescents is crucial to curb the global burden of cardiovascular diseases. We aim to provide global, regional, and national estimates of the prevalence of metabolic syndrome in children and adolescents to support the development of evidence-based prevention strategies. METHODS: In this systematic review with modelling analysis, we searched PubMed, Embase, Africa Journal Online, and Global Index Medicus from database inception to Jan 30, 2021, with no restriction on language or geographical location. We included community-based and school-based cross-sectional studies and cross-sectional analysis of cohort studies that reported prevalence of metabolic syndrome in the general population of children (6-12 years) and adolescents (13-18 years). Only studies with a low risk of bias were considered. Eligible studies included at least 200 participants and used probabilistic-based sampling. Diagnosis of metabolic syndrome had to meet at least three of the following criteria: high systolic or diastolic blood pressure (≥90th percentile for age, sex, and height); waist circumference in at least the 90th percentile for age, sex, and ethnic group; fasting plasma glucose 5·6 mmol/L or greater; fasting plasma triglycerides 1·24 mmol/L or greater; and fasting plasma high density lipoprotein cholesterol 1·03 mmol/L or less. Independent investigators selected eligible studies and extracted relevant data. The primary outcome was a crude estimate of metabolic syndrome prevalence, assessed using a Bayesian hierarchical model. FINDINGS: Our search yielded 6808 items, of which 169 studies were eligible for analysis, including 306 prevalence datapoints, with 550 405 children and adolescents from 44 countries in 13 regions. The between-study variance (τ2) was 0·52 (95% CI 0·42-0·67), which could reflect the measurement of each component of the metabolic syndrome and covariates as sources of between-study heterogeneity. We estimated the global prevalence of metabolic syndrome in 2020 at 2·8% (95% uncertainty interval [UI] 1·4-6·7) for children and 4·8% (2·9-8·5) for adolescents, equating to around 25·8 (12·6-61·0) million children and 35·5 (21·3-63·0) million adolescents living with metabolic syndrome. In children, the prevalence of metabolic syndrome was 2·2% (95% UI 1·4-3·6) in high-income countries, 3·1% (2·5-4·3) in upper-middle-income countries, 2·6% (0·9-8·3) in lower-middle-income countries, and 3·5% (1·0-8·0) in low-income countries. In adolescents, the prevalence of metabolic syndrome was 5·5% (4·1-8·4) in high-income countries, 3·9% (3·1-5·4) in upper-middle-income countries, 4·5% (2·6-8·4) in lower-middle-income countries, and 7·0% (2·4-15·7) in low-income countries. Prevalence in children varied from 1·4% (0·6-3·1) in northwestern Europe to 8·2% (6·9-10·1) in Central Latin America. Prevalence for adolescents ranged from 2·9% (95% UI 2·6-3·3) in east Asia to 6·7% (5·9-8·3) in high-income English-speaking countries. The three countries with the highest prevalence estimates in children were Nicaragua (5·2%, 2·8-10·4), Iran (8·8%, 8·0-9·6), and Mexico (12·3%, 11·0-13·7); and the three countries with the highest prevalence estimates in adolescents were Iran (9·0%, 8·4-9·7), United Arab Emirates (9·8%, 8·5-10·3), and Spain (9·9%, 9·1-10·8). INTERPRETATION: In 2020, about 3% of children and 5% of adolescents had metabolic syndrome, with some variation across countries and regions. The prevalence of metabolic syndrome was not consistently higher with increasing level of development, suggesting that the problem is not mainly driven by country wealth. The high number of children and adolescents living with metabolic syndrome globally highlights the urgent need for multisectoral interventions to reduce the global burden of metabolic syndrome and the conditions that lead to it, including childhood overweight and obesity. FUNDING: None.

Geographic distribution of metabolic syndrome and its components in the general adult population: A meta-analysis of global data from 28 million individuals.

AIMS: Better knowledge of the global metabolic syndrome (MetS) prevalence and its components is a prerequisite to curb the related burden. METHODS: We systematically searched PubMed, EMBASE, Web of Knowledge, Africa Journal Online, Global Index Medicus up to May 23, 2021. Prevalence pooling was done with a random-effects meta-analysis. RESULTS: In total, 1,129 prevalence data (28,193,768 participants) were included. The MetS global prevalence varied from 12.5% (95 %CI: 10.2-15.0) to 31.4% (29.8-33.0) according to the definition considered. The prevalence was significantly higher in Eastern Mediterranean Region and Americas and increased with country's level of income. The global prevalence was 45.1% (95 %CI: 42.1-48.2) for ethnic-specific central obesity, 42.6% (40.3-44.9) for systolic blood pressure (BP) ≥ 130 mmHg and/or diastolic BP ≥ 85 mmHg, 40.2% (37.8-42.5) for HDL-cholesterol < 1.03 for men or < 1.29 mmol/L for women, 28.9% (27.4-30.5) for serum triglycerides ≥ 1.7 mmol/L, and 24.5% (22.5-26.6) for fasting plasma glucose ≥ 5.6 mmol/L. CONCLUSIONS: This study reveals that MetS and its related cardiometabolic components are highly prevalent worldwide. This study calls for more aggressive and contextualized public health interventions to tackle these conditions.

Meta-Analysis of the Incidence, Prevalence, and Correlates of Atrial Fibrillation in Rheumatic Heart Disease.

Objective: To estimate the incidence, prevalence, and correlates of atrial fibrillation (AF) in a global population with rheumatic heart disease (RHD). Methods: Bibliographic databases were searched to identify all published studies providing data on AF in patients with RHD. Random-effects meta-analysis method was used to pool estimates. Results: Eighty-three studies were included, reporting data from 75,637 participants with RHD in 42 countries. The global prevalence of AF in RHD was 32.8% (range: 4.3%-79.9%). It was higher in severe valvular disease (30.8% vs 20.7%, p = 0.009), in severe mitral valve disease compared to severe aortic disease (30.4% vs 6.3%, p = 0.038). The global cumulative incidence of AF in patients with RHD was 4.8%, 11.4%, 13.2%, and 30.8% at 1, 2, 5, and 10 years of follow-up, respectively. From comparison between patients with and without AF, AF was associated with increased age (mean difference [MD]: 9.5 years; 95% CI: 7.8-1.3), advanced heart failure (odds ratio [OR]: 4.4; 95% CI 2.1-9.3), tricuspid valve involvement (OR: 4.0; 95% CI: 3.0-5.3), history of thromboembolism (OR: 6.2; 95% CI: 3.4-11.4), highly sensitive C-reactive protein (MD: 5.5 mg/dL; 95% CI: 1.2-9.8), systolic pulmonary arterial pressure (MD: 3.6 mmHg; 95% CI: 0.8-6.3), right atrium pressure (MD: 1.5 mmHg; 95% CI: 1.0-2.0), and left atrium diameter (MD: 8.1 mm; 95% CI: 5.5-10.7). Conclusions: About one-third of patients with RHD have AF, with an incidence which almost triples every five years after diagnosis. Factors associated with AF include age, advanced heart failure, thromboembolism, and few cardiac hemodynamics parameters.

Active smoking among people with diabetes mellitus or hypertension in Africa: a systematic review and meta-analysis.

The objective was to summarize existing data on the prevalence of active tobacco smoking among patients with hypertension or diabetes mellitus in Africa. We searched PubMed, EMBASE, and AJOL to include studies published from January 01, 2000 to August 23, 2017 reporting on the prevalence of active smoking in individuals aged ≥15 years with hypertension or diabetes mellitus residing inside Africa. We used a random-effects meta-analysis model to pool studies. The pooled prevalence of active smoking among patients with hypertension or diabetes was 12.9% (95%CI: 10.6-15.3; 50 studies; 16,980 patients) and 12.9% (95%CI: 9.6-16.6; 42 studies; 18,564 patients), respectively. For both conditions, the prevalence of active smoking was higher in males than in females (p < 0.001), and in Northern compared to sub-Saharan Africa (p < 0.001). There was no difference between urban and rural settings, and between community-based and hospital-based studies, except for patients with diabetes for whom the prevalence was higher in hospital-based studies (p = 0.032). The prevalence of active smoking is high among patients with hypertension or diabetes mellitus in Africa, with the heaviest burden in Northern Africa. Interventions for smoking prevention or cessation should be implemented in these high risk populations, targeting particularly the males.

Hepatitis B virus and HIV coinfection among adults residing in Cameroon: A systematic review and meta-analysis of prevalence studies.

BACKGROUND: This systematic review and meta-analysis was conducted to determine the prevalence of hepatitis B virus (HBV) and human immunodeficiency virus (HIV) coinfection among adults in Cameroon. METHODS: We searched PubMed, EMBASE, Web of Science, Global Index Medicus, and Africa Journal Online with no language restriction to identify articles published from Jan 1996 until Dec 2017. We considered observational studies conducted in apparently healthy populations (pregnant women, blood donors, and general population). We used a random-effects model to pool data. RESULTS: We included 24 studies (23,295 participants) from seven of the ten regions in Cameroon. Four, 20, and no studies had low, moderate, and high risk of bias respectively. The overall HBV-HIV coinfection prevalence was 0.8% (95%CI 0.5-1.0; 11 studies). The overall HBV prevalence in people with HIV was 12.9% (95%CI 9.7-16.5; 20 studies). The HBV prevalence in people with HIV was significantly higher in rural compared to urban. No study reported the prevalence of HIV infection in people with HBV. CONCLUSIONS: Although we found a low prevalence of HIV-HBV coinfection in Cameroon, this study presented a high HBV prevalence in people with HIV. Effective strategies to interrupt the transmission of HBV are required, especially among people with HIV infection in rural areas.