Hepatitis B virus seroprevalence, associated factors, and liver fibrosis burden among people living with HIV in Uganda: a systematic review

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Abstract Background Hepatitis B virus (HBV) and HIV coinfection remains an important cause of liver-related morbidity and mortality in sub-Saharan Africa. Uganda carries a substantial burden of both infections, yet evidence on HBV seroprevalence, associated factors, and liver fibrosis among people living with HIV (PLHIV) has not been comprehensively synthesized. This systematic review aimed to summarize available evidence from Uganda on HBV seroprevalence, correlates of HBV infection, and liver fibrosis burden among PLHIV. Methods This systematic review was conducted and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 statement. We searched PubMed/MEDLINE, Scopus, Web of Science, African Journals Online (AJOL), WHO Global Index Medicus, Google Scholar, and medRxiv/bioRxiv from inception to December 2025 for studies conducted in Uganda among PLHIV reporting HBsAg seroprevalence, factors associated with HBV infection, or liver fibrosis outcomes. Eligible studies included observational designs. Two reviewers independently screened studies, extracted data, and assessed methodological quality using the Joanna Briggs Institute (JBI) critical appraisal tools. Findings were synthesized narratively. Results A total of 14 studies were included. Most studies were cross-sectional and were conducted in Northern Uganda, Central Uganda, South-Western Uganda, and Lake Victoria fishing communities. Reported HBsAg seroprevalence among PLHIV varied across settings, with higher estimates generally observed in Northern Uganda and fishing communities than in some urban clinic-based populations. Frequently reported factors associated with HBV infection included male sex, older age, lower CD4 cell count, and rural or high-risk residence. Studies assessing liver fibrosis suggested a greater burden of significant fibrosis among HBV-HIV coinfected individuals compared with HIV-monoinfected populations, although fibrosis definitions and diagnostic methods varied substantially across studies. Conclusions Available evidence indicates that HBV infection remains a significant comorbidity among PLHIV in Uganda, with substantial variation in seroprevalence across geographic settings. Male sex, older age, lower CD4 cell count, and residence in higher-burden settings were among the most frequently reported associated factors. Studies also suggest a greater burden of liver fibrosis among HBV-HIV coinfected individuals than among HIV-monoinfected populations. However, interpretation of findings is limited by methodological heterogeneity and the predominance of cross-sectional studies. Systematic review registration PROSPERO CRD420261349477.