Evolution of liver fibrosis in HIV/HBV-coinfected patients receiving antiretroviral treatment: a systematic review and meta-analysis

Background Liver fibrosis is a serious problem in the context of HIV/HBV coinfection, where the risk of accelerated liver damage is increased. However, comprehensive estimates of its dynamics remain limited worldwide. This review aims to assess liver fibrosis evolution in HIV/HBV coinfected patients under antiretroviral treatment (ART). Method We conducted a systematic review and meta-analysis of studies published in PubMed and Google Scholar between 2010 and 2025. Longitudinal studies assessing liver fibrosis evolution in HIV/HBV coinfected patients were included. Cross-sectional studies, case reports, systematic reviews, and studies with no longitudinal follow-up were excluded. The risk of bias was assessed via the Joanna Briggs Institute (JBI) tool for cohort studies. Meta-analyses were conducted using a random effects model to estimate the pooled prevalence of liver fibrosis progression and regression of liver fibrosis, with 95% confidence intervals. Results Database searches resulted in the identification of 894 articles. After various selection processes, a total of 22 articles were included. The estimated pooled prevalence of liver fibrosis progression was 16.55% (95% CI: 10.07–23.03), and the pooled prevalence of liver fibrosis regression was 56.15% (95% CI: 34.58–77.73). Liver fibrosis progression was significantly associated with male sex (OR = 3.34, 95% CI: 1.56–7.17) and low CD4 nadir (OR = 3.09, 95% CI: 1.57–6.10). Conclusion This study documents the beneficial effect of current antiretroviral therapy on liver fibrosis regression in HIV/HBV co-infected patients. However, these benefits remain heterogeneous, as hepatic outcomes are influenced by patient-specific factors not fully addressed by current therapeutic strategies. These findings support the need to evaluate new therapeutic protocols aimed at reducing the burden of liver fibrosis in high-risk HIV/HBV co-infected patients, particularly those with a low CD4 nadir and men. Trial registration The protocol was registered in the Prospero database CRD42025641308.