Cross-sectional Assessment of HIV and Hepatitis A, B, C, D, and E among Individuals Surveyed in National Health and Nutrition Evaluation Survey, 1999–2018

Abstract

Objective: To assess the association with HIV with five strains of viral hepatitis, in adults 18-59 years, who have taken the NHANES survey for HIV, and to determine if there is a positive association with HIV in each of the five viral hepatitis strains adjusted by age, gender, and race. Methods: Cross-sectional analysis of HIV Screening Test by Laboratory test results for Hepatitis A, B, C, D, and E screenings, using 10 pooled datasets from the 1999-2018 biennial National Health and Nutritional Examination Surveys. Statistical analyses performed included Spearman’s Correlations, weighted Rao-Scott Chi-Square tests, and weighted binary logistic regression modeling. Results: In the subset of 33,214 adult participants surveyed in the 1999-2018 NHANES the percentage of HIV positivity was 0.44% (standard error=0.05), with 56% occurring in 2009-2018. Weighted Rao-Scott Chi-Square Tests had a statistically significant association between HIV and the five hepatitis strains, with four having a p-value <=0.0001, except for Hepatitis D. After adjustment by age, race, and gender HIV was positively associated odds ratios. Hepatitis A had a statistically significant odds ratio for 1999-2018 but was not significant for 1999-2006 and 2007-2018. Hepatitis B and Hepatitis C had a statistically significant association in all three subsets. Hepatitis D had no HIV coinfection in 1999-2006, so it was not reported, and a nonsignificant association in 2009-2018. Hepatitis E, which started collection in 2009, had a nonsignificant association with HIV in 2009-2018. Conclusion: Based on this analysis and the review of HIV and viral hepatitis guidelines it is suggested that immunocompromised individuals, including HIV positives, should be screened for all five strains of viral Hepatitis. Further research is needed in order to better understand the connection between HIV and viral hepatitis strains, especially Hepatitis A, Hepatitis D, or Hepatitis E.