Influence of intestinal schistosome and hepatitis B or C coinfection on hepatic disease: A systematic review and meta-analysis.

[OBJECTIVES] This study aimed to improve the understanding of the relative influence of schistosome and viral hepatitis coinfection on liver disease.

[METHODS] We conducted a meta-analysis adhering to PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines to examine intestinal schistosome and hepatitis B or C coinfection in relation to liver fibrosis, cirrhosis, and hepatocellular carcinoma (PROSPERO CRD42023443435). Inverse-variance weighted random effects were used to calculate pooled effect sizes. Subgroup analyses were conducted for study aims, region, species, diagnostic tools, and reference categories of singularly infected vs uninfected.

[RESULTS] Out of 1984 studies screened, 33 full-text articles including 8637 participants were eligible for meta-analysis. Among the included studies, 57% (19/33) investigated coinfection with hepatitis C and Schistosoma mansoni. Individuals with any coinfection had three times higher odds of liver fibrosis or cirrhosis than singularly infected or uninfected individuals, and 2.29, 2.35, and 2.69 higher odds of liver fibrosis, cirrhosis, and hepatocellular carcinoma, respectively. Heterogeneity was moderate (I 64.02-68.31%). Schistosomal coinfections with hepatitis B had 6.08 times higher odds of liver fibrosis or cirrhosis. Among studies for which risk of bias could be assessed, 42.42% (14/32) were rated as low-quality.

[CONCLUSIONS] Guidelines for schistosomiasis and hepatitis B and C should account for coinfection when evaluating eligibility for treatment or prophylaxis and when determining morbidity management strategies.