Prevalence and risk factors for HIV, hepatitis B, and hepatitis C in people with severe mental illness: a total population study of Sweden

Abstract

SummaryBackgroundSevere mental illness is associated with increased morbidity and mortality. The elevated risk of blood-borne viruses (BBVs) in people with severe mental illness is of concern, but the full extent of this problem is unclear. We aimed to determine the prevalence of and risk factors for BBVs in people with severe mental illness.MethodsIn this nationwide, population-based, cross-sectional study, we estimated the point prevalence of HIV, hepatitis B (HBV), and hepatitis C (HCV) in people with severe mental illness, including the total adult (≥18 years) Swedish population. We defined severe mental illness as a clinical diagnosis of schizophrenia, schizoaffective disorder, bipolar disorder, or other psychotic illness according to the Swedish version of the International Statistical Classification of Diseases version 8, 9, or 10. We used multivariable logistic regression to determine the odds of BBVs in individuals with severe mental illness, relative to the general population, and to identify independent risk factors (age, sex, immigration status, socioeconomic status, education, and substance misuse) for BBV infection. We also did a sensitivity analysis excluding BBV diagnoses made before the introduction of the Register for Infection Disease Control (1997).FindingsOf 6 815 931 adults in Sweden, 97 797 (1·43%) individuals had a diagnosis of severe mental illness. Prevalence of BBVs was elevated in people with severe mental illness, of which 230 (0·24%) had HIV, 518 (0·53%) had HBV, and 4476 (4·58%) had HCV. After accounting for sociodemographic characteristics, the odds of HIV were 2·57 (95% CI 2·25–2·94, p<0·0001) times higher in people with severe mental illness than in the general population, whereas the odds of HBV were 2·29 (2·09–2·51, p<0·0001) times higher and the odds of HCV were 6·18 (5·98–6·39, p<0·0001) times higher. Substance misuse contributed most to the increased risk of BBV: after adjustment, odds ratios were 1·61 (1·40–1·85, p<0·0001) for HIV, 1·28 (1·16–1·41, p<0·0001) for HBV, and 1·72 (1·67–1·78, p<0·0001) for HCV.InterpretationOur results highlight the need to address the issue of higher prevalence of BBVs in people with severe mental illness and identify interventions preventing infection. Targeting of comorbid substance misuse would have particular effect on reduction of BBV prevalence in this population.FundingMedical Research Council and Swedish Research Council.

HBV, HCV, and HBV/HCV co‐infection among HIV‐positive patients in Hunan province, China: Regimen selection, hepatotoxicity, and antiretroviral therapy outcome

“…Previous studies also reported that HIV/HBV/HCV co-infected patients have a higher mortality rate than each of the HIV/HCV and HIV/HBV co-infected patients. 52,53 We were not able to show this but we only had a small sample size of triple co-infection patients in our study. Currently, there are no recommendations for treating triple co-infection patients in the latest Chinese treatment guidelines.…”

Adverse events in psychiatry: a national cohort study in Sweden with a unique psychiatric trigger tool

“…In a national Swedish survey, the patient safety culture was rated lower than in somatic care [32]. The lack of documentation of physical status during psychiatric hospital care is troublesome, as patients with a serious mental illness have higher rates of physical conditions, such as obesity, diabetes, hypertension and HIV/AIDS [33,34], and risk behaviour, such as smoking, drinking alcohol and physical inactivity [35].…”

Association of Hydroxylmethyl Glutaryl Coenzyme A Reductase Inhibitors, L-Type Calcium Channel Antagonists, and Biguanides With Rates of Psychiatric Hospitalization and Self-Harm in Individuals With Serious Mental Illness

“…We defined diagnoses of BPD, schizophrenia, and NAP in line with previous research using Swedish National Patient Registers. 12 , 13 Individuals had at least 1 record of inpatient or outpatient contact with codes from the International Classification of Diseases, Ninth Revision ( ICD-9 ) and International Statistical Classification of Diseases and Related Health Problems, Tenth Revision ( ICD-10 ) consistent with the diagnosis (eTable 1 in the Supplement ) and a period of drug treatment with an appropriate psychotropic medication (antipsychotic, lithium, or anticonvulsant class mood stabilizer) from October 1, 2005, through December 31, 2016. Validation studies suggest that using inpatient SMI diagnosis alone has high positive predictive power (0.94) but potentially misses suitable patients owing to type II error (negative predictive power, 0.23).…”