Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Virol. Mar 25, 2021; 10(2): 69-85
Published online Mar 25, 2021. doi: 10.5501/wjv.v10.i2.69
Epidemiological characterization and geographic distribution of human immunodeficiency virus/acquired immunodeficiency syndrome infection in North African countries
Mohamed A Daw, Mohamed O Ahmed
Mohamed A Daw, Department of Medical Microbiology and Immunology, Faculty of Medicine, University of Tripoli, Tripoli cc82668, Tripoli, Libya
Mohamed O Ahmed, Department of Microbiology and Parasitology, Faculty of Veterinary Medicine, University of Tripoli, Tripoli cc82668, Tripoli, Libya
Author contributions: Daw MA designed the research study and wrote the manuscript; Ahmed MO and Daw MA analyzed the data; all authors have read and approved the final manuscript.
Conflict-of-interest statement: The authors declare that they have no competing interests.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Mohamed A Daw, BM BCh, BPharm, FTCDI, MD, PharmD, PhD, Academic Fellow, Professor, Department of Medical Microbiology and Immunology, Faculty of Medicine, University of Tripoli, Alfrnaj Street, Tripoli cc82668, Tripoli, Libya.
Received: November 4, 2020
Peer-review started: November 4, 2020
First decision: December 11, 2020
Revised: December 22, 2020
Accepted: January 8, 2021
Article in press: January 8, 2021
Published online: March 25, 2021

Human immunodeficiency virus (HIV) infection is a major global public health concern. North African countries carry a disproportionate burden of HIV representing one of the highest rates in Africa.


To characterize the epidemiological and spatial trends of HIV infection in this region.


A systematic review was carried out on all the published data regarding HIV/acquired immunodeficiency syndrome in North African countries over ten years (2008-2017) following the PRISMA guidelines. We performed a comprehensive literature search using Medline PubMed, Embase, regional and international databases, and country-level reports with no language restriction. The quality, quantity, and geographic coverage of the data were assessed at both the national and regional levels. We used random-effects methods, spatial variables, and stratified results by demographic factors. Only original data on the prevalence of HIV infection were included and independently evaluated by professional epidemiologists.


A total of 721 records were identified but only 41 that met the criteria were included in the meta-analysis. There was considerable variability in the prevalence estimates of HIV within the countries of the region. The overall prevalence of HIV ranged from 0.9% [95% confidence interval (CI) 0.8-1.27] to 3.8% (95%CI 1.17-6.53). The highest prevalence was associated with vulnerable groups and particularly drug abusers and sexually promiscuous individuals. The dense HIV clustering noted varied from one country to another. At least 13 HIV subtypes and recombinant forms were prevalent in the region. Subtype B was the most common variant, followed by CRF02_AG.


This comprehensive review indicates that HIV infection in North African countries is an increasing threat. Effective national and regional strategies are needed to improve monitoring and control of HIV transmission, with particular emphasis on geographic variability and HIV clustering.

Keywords: North Africa, Human immunodeficiency virus/acquired immunodeficiency syndrome, Epidemiological analysis, Geographic distribution, Meta-analysis, Risk factors

Core Tip: North Africa is a unique geographical region located on the southern Mediterranean basin and represents the largest region of Africa. Human immunodeficiency virus (HIV) infection is an increasing threat in this region. Previous studies analyzed mainly the risk factors associated with risk groups at a national level and no single study has yet analyzed the actual epidemiological situation of HIV/acquired immunodeficiency syndrome (AIDS) in the whole region. This review aims to analyze and characterize the epidemiological and geographic variation of HIV/AIDS in North African countries and to highlight the strategies needed to combat this epidemic at the national and regional levels.