Global Prevalence of Human Pegivirus-1 (HPgV-1) Infection among HIV-Positive Patients and the Impact of HPgV-1 on HIV Viral Load and CD4 Cell Count: A Systematic Review and Meta-Analysis

Background: Human pegivirus-1 (HPgV-1) was first identified in 1996. The impact of HPgV-1 on HIV viral load and CD4 cell count is controversial. This study aimed to assess the global prevalence of HPgV-1/HIV coinfection and the impact of HPgV-1
on HIV viral load and CD4 cell count.
Materials & Methods: A literature search was performed in PubMed, Scopus, EMBASE, Web of Science, ProQuest, Cochrane, and Global Index Medicus (GIM) up to January 2026. The I2 statistic and Cochran’s Q test were used to assess heterogeneity. Subgroup analyses were carried out to find potential causes of heterogeneity. Funnel plot and Egger’s test were used to assess publication bias.
Findings: A total of 86 studies with 19050 HIV-positive cases, published from 1997 to 2023 and covering 36 different countries, were included in this meta-analysis. The overall prevalence of HPgV-1 among HIV-positive patients was 25.3%. The prevalence of HIV/ HPgV-1 coinfection in different continents was as follows: 26.5% in Africa, 21.9% in Asia, 26.7% in Europe, 24.6% in North America, and 25.1% in South America. The overall mean of CD4 cell count was significantly different between HPgV-1-positive and HPgV-1-negative patients, while the overall mean of HIV viral load was not significantly different.
Conclusion: In this meta-analysis, the global prevalence of HPgV-1/HIV coinfection was 25.3%, with coinfected patients showing higher CD4 cell counts (p= .004) but no impact on HIV viral load. The results suggest that HPgV-1 may modulate HIV progression, though mechanisms remain unclear. Larger longitudinal studies are needed to confirm clinical significance and explore genotype-specific effects.