Re: ‘Prevalence of human immunodeficiency virus, syphilis, and hepatitis B and C virus infections in pregnant women: a systematic review and meta-analysis’ by Wu et al.

We read with interest the article entitled “Prevalence of human immunodeficiency virus, syphilis, and hepatitis B and C virus infections in pregnant women: a systematic review and meta-analysis” recently published in Clin Microbiol Infect [[1]Wu S. Wang J. Guo Q. Lan H. Sun Y. Ren M. et al.Prevalence of human immunodeficiency virus, syphilis, and hepatitis B and C virus infections in pregnant women: a systematic review and meta-analysis.Clin Microbiol Infect. 2023; 29: 1000-1007https://doi.org/10.1016/j.cmi.2023.03.002Abstract Full Text Full Text PDF Scopus (0) Google Scholar]. In their article, Wu et al. calculated that the global pooled prevalence of HIV infection in pregnant women is as high as 2.9% (95% confidence interval 2.4–3.4%) [[1]Wu S. Wang J. Guo Q. Lan H. Sun Y. Ren M. et al.Prevalence of human immunodeficiency virus, syphilis, and hepatitis B and C virus infections in pregnant women: a systematic review and meta-analysis.Clin Microbiol Infect. 2023; 29: 1000-1007https://doi.org/10.1016/j.cmi.2023.03.002Abstract Full Text Full Text PDF Scopus (0) Google Scholar]. The World Health Organization (WHO) reported that approximately 1.3 million women living with human immunodeficiency virus (HIV) worldwide become pregnant each year [[2]World Health Organization. Mother-to-child transmission of HIV. https://www.who.int/teams/global-hiv-hepatitis-and-stis-programmes/hiv/prevention/mother-to-child-transmission-of-hiv. [Accessed September 14, 2022].Google Scholar]. This estimation is widely recognized [[3]Eke A.C. Mirochnick M. Lockman S. Antiretroviral Therapy and Adverse Pregnancy Outcomes in People Living with HIV.N Engl J Med. 2023; 388: 344-356https://doi.org/10.1056/NEJMra2212877Crossref Scopus (2) Google Scholar,[4]Bailey H. Zash R. Rasi V. Thorne C. HIV treatment in pregnancy.Lancet HIV. 2018; 5: e457-e467https://doi.org/10.1016/S2352-3018(18)30059-6Abstract Full Text Full Text PDF PubMed Scopus (64) Google Scholar]. Based on the fact that there are annually approximately 135 million pregnant women who give live births [[5]United Nations. World Population Prospects 2022 Summary of Results. https://www.un.org/development/desa/pd/sites/www.un.org.development.desa.pd/files/wpp2022_summary_of_results.pdf. [Accessed September 14, 2022].Google Scholar], the estimated prevalence of HIV infection in pregnant women worldwide should be lower than 1%. Hence, the reported global 2.9% prevalence of HIV in pregnant women in Wu et al.’s article [[1]Wu S. Wang J. Guo Q. Lan H. Sun Y. Ren M. et al.Prevalence of human immunodeficiency virus, syphilis, and hepatitis B and C virus infections in pregnant women: a systematic review and meta-analysis.Clin Microbiol Infect. 2023; 29: 1000-1007https://doi.org/10.1016/j.cmi.2023.03.002Abstract Full Text Full Text PDF Scopus (0) Google Scholar] is much higher than the prevalence calculated by the WHO reports. To support their conclusion, Wu et al. mentioned in the discussion of their article that the pooled prevalence of HIV infection in pregnant women is similar to the prevalence (3.6%) in the general population by citing two references (ref 27 and 28 in their article [[1]Wu S. Wang J. Guo Q. Lan H. Sun Y. Ren M. et al.Prevalence of human immunodeficiency virus, syphilis, and hepatitis B and C virus infections in pregnant women: a systematic review and meta-analysis.Clin Microbiol Infect. 2023; 29: 1000-1007https://doi.org/10.1016/j.cmi.2023.03.002Abstract Full Text Full Text PDF Scopus (0) Google Scholar]) [[6]World Health Organization. Data on the size of the HIV epidemic. https://www.who.int/data/gho/data/themes/hiv-aids/data-on-the-size-of-the-hiv-aids-epidemic. [Accessed September 14, 2022].Google Scholar,[7]Platt L. Easterbrook P. Gower E. McDonald B. Sabin K. McGowan C. Yanny I. Razavi H. Vickerman P. Prevalence and burden of HCV co-infection in people living with HIV: a global systematic review and meta-analysis.Lancet Infect Dis. 2016; 16: 797-808https://doi.org/10.1016/S1473-3099(15)00485-5Abstract Full Text Full Text PDF PubMed Scopus (482) Google Scholar]. However, neither of these two references [[6]World Health Organization. Data on the size of the HIV epidemic. https://www.who.int/data/gho/data/themes/hiv-aids/data-on-the-size-of-the-hiv-aids-epidemic. [Accessed September 14, 2022].Google Scholar,[7]Platt L. Easterbrook P. Gower E. McDonald B. Sabin K. McGowan C. Yanny I. Razavi H. Vickerman P. Prevalence and burden of HCV co-infection in people living with HIV: a global systematic review and meta-analysis.Lancet Infect Dis. 2016; 16: 797-808https://doi.org/10.1016/S1473-3099(15)00485-5Abstract Full Text Full Text PDF PubMed Scopus (482) Google Scholar] presents 3.6% prevalence of HIV in general population; WHO (ref 27 in Wu et al’s article [[1]Wu S. Wang J. Guo Q. Lan H. Sun Y. Ren M. et al.Prevalence of human immunodeficiency virus, syphilis, and hepatitis B and C virus infections in pregnant women: a systematic review and meta-analysis.Clin Microbiol Infect. 2023; 29: 1000-1007https://doi.org/10.1016/j.cmi.2023.03.002Abstract Full Text Full Text PDF Scopus (0) Google Scholar]) reported that there were approximately 39.0 million people living with HIV at the end of 2022 globally, and the prevalence of HIV is 0.7% among adults aged 15–49 years worldwide [[6]World Health Organization. Data on the size of the HIV epidemic. https://www.who.int/data/gho/data/themes/hiv-aids/data-on-the-size-of-the-hiv-aids-epidemic. [Accessed September 14, 2022].Google Scholar], and Platt et al (ref 28 in Wu et al’s article [[1]Wu S. Wang J. Guo Q. Lan H. Sun Y. Ren M. et al.Prevalence of human immunodeficiency virus, syphilis, and hepatitis B and C virus infections in pregnant women: a systematic review and meta-analysis.Clin Microbiol Infect. 2023; 29: 1000-1007https://doi.org/10.1016/j.cmi.2023.03.002Abstract Full Text Full Text PDF Scopus (0) Google Scholar]) mentioned that there were 36.9 million people infected with HIV as of December, 2014 [[7]Platt L. Easterbrook P. Gower E. McDonald B. Sabin K. McGowan C. Yanny I. Razavi H. Vickerman P. Prevalence and burden of HCV co-infection in people living with HIV: a global systematic review and meta-analysis.Lancet Infect Dis. 2016; 16: 797-808https://doi.org/10.1016/S1473-3099(15)00485-5Abstract Full Text Full Text PDF PubMed Scopus (482) Google Scholar]. The Joint United Nations Programme on HIV/AIDS (UNAIDS) also reported that 39.0 million people globally were living with HIV in 2022 [[8]The Joint United Nations Programme on HIV/AIDS (UNAIDS). Global HIV & AIDS statistics — Fact sheet. https://www.unaids.org/en/resources/fact-sheet. [Accessed September 14, 2022].Google Scholar]. Based on the total number of peoples living with HIV and the global whole population (approximately 8 billion) in the world [[5]United Nations. World Population Prospects 2022 Summary of Results. https://www.un.org/development/desa/pd/sites/www.un.org.development.desa.pd/files/wpp2022_summary_of_results.pdf. [Accessed September 14, 2022].Google Scholar], the overall HIV prevalence in whole population is approximately 0.5%, rather 3.6%. Even in the most severely affected African Region, the overall HIV prevalence is around 3.2% [[6]World Health Organization. Data on the size of the HIV epidemic. https://www.who.int/data/gho/data/themes/hiv-aids/data-on-the-size-of-the-hiv-aids-epidemic. [Accessed September 14, 2022].Google Scholar]. Therefore, it is obviously that Wu et al mistakenly interpreted the HIV prevalence mentioned in these two references [[6]World Health Organization. Data on the size of the HIV epidemic. https://www.who.int/data/gho/data/themes/hiv-aids/data-on-the-size-of-the-hiv-aids-epidemic. [Accessed September 14, 2022].Google Scholar,[7]Platt L. Easterbrook P. Gower E. McDonald B. Sabin K. McGowan C. Yanny I. Razavi H. Vickerman P. Prevalence and burden of HCV co-infection in people living with HIV: a global systematic review and meta-analysis.Lancet Infect Dis. 2016; 16: 797-808https://doi.org/10.1016/S1473-3099(15)00485-5Abstract Full Text Full Text PDF PubMed Scopus (482) Google Scholar]. Estimation of HIV prevalence in pregnant women worldwide is important to achieve the goal of elimination of mother-to-child transmission of HIV by 2030. However, exaggerated prevalence of HIV in pregnant women may cause unnecessary panic and overreactions in public and lead to inadequate allocation of medical resources, which appear to be harmful in the prevention of mother-to-child transmission of HIV. Yi-Hua Zhou and Hong Zhao both contributed to the conception, drafting and revision of this work. We declare no competing interests. This study was supported by grants from the Health Commission of Nanjing City (ZKX20021), Science and Technology Department of Jiangsu Province (BK20221169), and Jiangsu Province Center for Innovation in Obstetrics and Gynecology (CXZX202229). Prevalence of human immunodeficiency virus, syphilis, and hepatitis B and C virus infections in pregnant women: a systematic review and meta-analysisClinical Microbiology and InfectionVol. 29Issue 8PreviewAt the 74th World Health Assembly, the WHO issued a strategy for the prevention and control of several major infectious diseases. To achieve the WHO-initiated targets for these infectious diseases, the elimination of mother-to-child transmission is essential. To date, a systematic review of the global and regional prevalence of infections with relevant mother-to-child transmission and outside the spectrum of congenital infections is lacking. Full-Text PDF Open Access