Survival of HIV-positive individuals with hepatitis B and C infection in Michigan

Butt, Zahid A; Wilkins, Melinda J.; Hamilton, Elizabeth; Todem, David; Gardiner, Joseph C.; Saeed, Mahdi

doi:10.1017/s0950268813003038

Cited by 5 publications

(4 citation statements)

References 35 publications

(62 reference statements)

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“…All infection groups were associated with a higher risk of mortality; however, the lowest risk was observed in the HIV-monoinfected group, possibly reflecting the impact of the HIV program in British Columbia, where HIV care and support, including antiretroviral treatment, is provided at no cost [ 24 ]. Individuals with HIV and HCV coinfection and those with HBV/HIV and HCV/HBV coinfection also had reduced survival, as reported previously by other studies [ 7 , 25 ]; however, the magnitude of risk of mortality in the coinfection groups in our study was higher than most studies [ 16 , 23 ], including meta-analyses on HIV/HBV coinfection [ 26 ] and HIV/HCV coinfection [ 27 ]. This highlights the need to account for the transition from no infection to infection status in analysis to accurately estimate the incremental risk of mortality, which has not previously been in other studies [ 16 , 23 ].…”

Section: Discussionsupporting

confidence: 84%

Concurrent Hepatitis C and B Virus and Human Immunodeficiency Virus Infections Are Associated With Higher Mortality Risk Illustrating the Impact of Syndemics on Health Outcomes

Butt

Wong

Rossi

et al. 2020

Open Forum Infectious Diseases

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Background Hepatitis C (HCV) and B (HBV) virus and HIV infections are associated with significant mortality globally, and in North America. However, data on impact of concurrent multiple infections on mortality risk is limited. We evaluated the effect of HCV, HBV and HIV infections, coinfections and associated factors on all-cause mortality in British Columbia (BC), Canada. Methods The BC Hepatitis Testers Cohort includes ~ 1.7 million individuals tested for HCV or HIV, or reported as a case of HCV, HIV, or HBV from 1990-2015, linked to administrative databases. We followed people with HCV, HBV or HIV mono-infection, co-infections, and triple infections from their negative status to date of death or December 31, 2016. Extended Cox proportional hazards regression was used to estimate hazard ratios (HR) and 95% confidence intervals (CIs) for factors associated with all-cause mortality. Results Of 658,704 individuals tested for HCV, HBV, and HIV, there were 33,804 (5.13%) deaths. In multivariable Cox regression analysis, individuals with HCV/HBV/HIV [HR:8.9, 95% CI:8.2-9.7] infections had the highest risk of mortality followed by HCV/HIV [HR:4.8, 95% CI:4.4-5.1], HBV/HIV [HR:4.1, 95%CI:3.5-4.8] , HCV/HBV [HR:3.9, 95%CI:3.7-4.2], HCV [HR:2.6 95%CI:2.6-2.7], HBV [HR:2.2, 95%CI:2.0-2.3]), HIV [HR:1.6, 95%CI:1.5-1.7]. Additional factors associated with mortality included injection drug use, problematic alcohol use, material deprivation, diabetes, chronic kidney disease, heart failure, and hypertension. Conclusions Concurrent multiple infections are associated with high mortality risk. Substance use, comorbidities and material disadvantage were significantly associated with mortality independent of co-infection. Preventive interventions, including harm reduction combined with co-infection treatments could significantly reduce mortality.

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Section: Discussionsupporting

confidence: 84%

Concurrent Hepatitis C and B Virus and Human Immunodeficiency Virus Infections Are Associated With Higher Mortality Risk Illustrating the Impact of Syndemics on Health Outcomes

Butt

Wong

Rossi

et al. 2020

Open Forum Infectious Diseases

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“…Globally, 2.7 million people have HIV–HCV coinfection, and of these 90% are among people who inject drugs (PWID) 1. HIV infection among HCV + individuals is a major predictor of morbidity2,3 and mortality 4,5. Highly effective, well-tolerated, short-course, direct-acting antiviral agents with cure rates approaching 95% have revolutionized the treatment of HCV.…”

Section: Introductionmentioning

confidence: 99%

Effect of opioid-substitution therapy and mental health counseling on HIV risk among hepatitis C-infected individuals

Butt

Shrestha

Gesink

et al. 2018

CLEP

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BackgroundUnderstanding differences in HIV incidence among people living with hepatitis C virus (HCV) can help inform strategies to prevent HIV infection. We estimated the time to HIV diagnosis among HCV-positive individuals and evaluated factors that could affect HIV-infection risk in this population.Patients and methodsThe British Columbia Hepatitis Testers Cohort includes all BC residents (~1.5 million: about a third of all residents) tested for HCV and HIV from 1990 to 2013 and is linked to administrative health care and mortality data. All HCV-positive and HIV-negative individuals were followed to measure time to HIV acquisition (positive test) and identify factors associated with HIV acquisition. Adjusted HRs (aHRs) were estimated using Cox proportional-hazard regression.ResultsOf 36,077 HCV-positive individuals, 2,169 (6%) acquired HIV over 266,883 years of follow-up (overall incidence of 8.1 per 1,000 person years). Overall median (IQR) time to HIV infection was 3.87 (6.06) years. In Cox regression, injection-drug use (aHR 1.47, 95% CI 1.33–1.63), HBV infection (aHR 1.34, 95% CI 1.16–1.55), and being a man who has sex with men (aHR 2.78, 95% CI 2.14–3.61) were associated with higher risk of HIV infection. Opioid-substitution therapy (OST) (aHR 0.59, 95% CI 0.52–0.67) and mental health counseling (aHR 0.48, 95% CI 0.43–0.53) were associated with lower risk of HIV infection.ConclusionInjection-drug use, HBV coinfection, and being a man who has sex with men were associated with increased HIV risk and engagement in OST and mental health counseling were associated with reduced HIV risk among HCV-positive individuals. Improving access to OST and mental health services could prevent transmission of HIV and other blood-borne infections, especially in settings where access is limited.

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“…In Canada, an estimated 230,000–450,000(0.66%–1.3%) individuals were infected with hepatitis C virus (HCV)[ 1 ] and about 75,500 were living with HIV at the end of 2014 [ 2 ]. Both HCV and HIV are associated with significant morbidity[ 3 ] and mortality [ 4 , 5 ]. HIV and HCV coinfected individuals have an increased risk of cirrhosis and decompensated liver disease [ 3 ], cardiovascular disease [ 6 ], Chronic Kidney Disease [ 7 ], and osteoporotic fractures[ 8 ].…”

Section: Introductionmentioning

confidence: 99%

A syndemic approach to assess the effect of substance use and social disparities on the evolution of HIV/HCV infections in British Columbia

et al. 2017

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BackgroundCo-occurrence of social conditions and infections may affect HIV/HCV disease risk and progression. We examined the changes in relationship of these social conditions and infections on HIV and hepatitis C virus (HCV) infections over time in British Columbia during 1990–2013.MethodsThe BC Hepatitis Testers Cohort (BC-HTC) includes ~1.5 million individuals tested for HIV or HCV, or reported as a case of HCV, HIV, HBV, or tuberculosis linked to administrative healthcare databases. We classified HCV and HIV infection status into five combinations: HIV-/HCV-, HIV+monoinfected, HIV-/HCV+seroconverters, HIV-/HCV+prevalent, and HIV+/HCV+.ResultsOf 1.37 million eligible individuals, 4.1% were HIV-/HCV+prevalent, 0.5% HIV+monoinfected, 0.3% HIV+/HCV+ co-infected and 0.5% HIV-/HCV+seroconverters. Overall, HIV+monoinfected individuals lived in urban areas (92%), had low injection drug use (IDU) (4%), problematic alcohol use (4%) and were materially more privileged than other groups. HIV+/HCV+ co-infected and HIV-/HCV+seroconverters were materially most deprived (37%, 32%), had higher IDU (28%, 49%), problematic alcohol use (14%, 17%) and major mental illnesses (12%, 21%). IDU, opioid substitution therapy, and material deprivation increased in HIV-/HCV+seroconverters over time. In multivariable multinomial regression models, over time, the odds of IDU declined among HIV-/HCV+prevalent and HIV+monoinfected individuals but not in HIV-/HCV+seroconverters. Declines in odds of problematic alcohol use were observed in HIV-/HCV+seroconverters and coinfected individuals over time.ConclusionsThese results highlight need for designing prevention, care and support services for HIV and HCV infected populations based on the evolving syndemics of infections and social conditions which vary across groups.

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Survival of HIV-positive individuals with hepatitis B and C infection in Michigan

Cited by 5 publications

References 35 publications

Concurrent Hepatitis C and B Virus and Human Immunodeficiency Virus Infections Are Associated With Higher Mortality Risk Illustrating the Impact of Syndemics on Health Outcomes

Concurrent Hepatitis C and B Virus and Human Immunodeficiency Virus Infections Are Associated With Higher Mortality Risk Illustrating the Impact of Syndemics on Health Outcomes

Effect of opioid-substitution therapy and mental health counseling on HIV risk among hepatitis C-infected individuals

A syndemic approach to assess the effect of substance use and social disparities on the evolution of HIV/HCV infections in British Columbia

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