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

Zahid A Butt ,Stanley Wong,Mark Gilbert,James C Johnston,Jane A Buxton,Theodora Consolacion,Jason Wong,Margot Kuo,Mel Krajden,Michelle Murti,Maria Alvarez,Naveed Z Janjua,Amanda Yu,Gina Ogilvie,Mark W Tyndall,Dionne Gesink,Robert Balshaw,Hasina Samji,David Roth,Nabin K Shrestha ,Travis Salway ,Victoria Cook

doi:10.1371/journal.pone.0183609

Abstract

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.

Highlights

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]
The BC Hepatitis Testers Cohort (BC-HTC) includes ~1.5 million individuals tested for HIV or HCV, or reported as a case of HCV, HIV, Hepatitis B Virus (HBV), or tuberculosis linked to administrative healthcare databases
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

Summary

Introduction

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]. Co-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

Methods

Results

Conclusion