3 Le Infezioni in Medicina, n. 1, 3-10, 2019 REVIEW Corresponding author Gaetano Scotto E-mail: gaetano.scotto@unifg.it n INTRODUCTION I n terms of infectious and tropical diseases, many geographical areas [sub-Saharan Afri- ca (SSA), Asia, Central and South America] are highly endemic, although with different epide- miological patterns for infections such as malaria parasites, hepatitis B virus, hepatitis C virus and human immunodeficiency virus. These pathol- ogies sometimes present with the same route of transmission (blood-to-blood contact, shared nee- dles and blood transfusions), such that it is not uncommon to have co-infections of several virus- es, plasmodia and viruses [1]. Several epidemiologic findings have reported synergy of malaria co-infections with viruses, including with hepatitis B virus, hepatitis C vi- rus, human immunodeficiency virus, and human parvovirus B19. Nevertheless, there is a paucity of research, especially in industrialized countries, regarding the effects of malaria and viral co-infec- tions on the affected host [2-4]. Epidemiological studies of HBV/malaria co-in- fection have been rare. The mutual interactions between HBV and malaria are poorly understood. In recent decades, thanks to studies carried out first in Brazil and subsequently in Sub Saharan Africa and Asia, there has been a greater aware- ness of the rates of this co-infection. Overlapping HBV/malaria may be more frequent than previ- ously believed, with possible influence on the nat- ural history of both diseases. The two pathogens share some development stages within the liver, a condition that could cause impaired clearance of Co-infection HBV and malaria: a striking association Gaetano Scotto 1 , Vincenzina Fazio 2 , Lorenzo Lo Muzio 3 1 Microbiology and Clinical Microbiology, Master’s Degree in Dentistry, Faculty of Medicine and Surgery, University of Foggia, Foggia, Italy; 2 Public Health and Preventive Medicine, and Clinical Laboratory Specialist, Foggia, Italy; 3 Clinical and Experimental Medicine Department, Faculty of Medicine and Surgery, University of Foggia, Foggia, Italy Many geographical areas are highly endemic for in- fectious tropical diseases, although in disproportional fashion. Various infections often overlap in terms of presentation of various epidemiological and clinical manifestations that are linked to the mutual influence of pathogens. The epidemiological and clinical aspects of hepatitis B virus and malaria co-infection remain lit- tle known because there have not been many studies until recently. We performed a systematic search of the epidemiology of HBV/malaria co-infection, in particu- lar, their overlapping clinical and histological features and their reciprocal conditioning. We examined pub- lished data regarding HBV and malaria. The data we obtained varied substantially. The interaction between SUMMARY malarial parasites and HBV viruses, both in chronic HBV hepatitis patients and in carriers, did not vary or change the clinical evolution of either infection. The di- versity of epidemiological and clinical results depend- ed both on the geographical areas in which the studies were carried out and on the various stages of the in- fections at the time of the study. Strategies to improve currently available diagnostic techniques, and studies dealing with vector control procedures and other op- erational tools and approaches are needed for better understanding of this health problem. Keywords: malaria, hepatitis B, co-infection, epidemi- ology