Abstract
BackgroundAs HIV and hepatitis C (HCV) share some modes of transmission co-infection is not uncommon. This study used a population-based sample of HIV and HCV tested individuals to determine the prevalence of HIV/HCV co-infection, the sequence of virus diagnoses, and demographic and associated risk factors.MethodsPositive cases of HIV were linked to the combined laboratory database (of negative and positive HCV antibody results) and HCV reported cases in British Columbia (BC).ResultsOf 4,598 HIV cases with personal identifiers, 3,219 (70%) were linked to the combined HCV database, 1,700 (53%) of these were anti-HCV positive. HCV was diagnosed first in 52% of co-infected cases (median time to HIV identification 3 1/2 years). HIV and HCV was diagnosed within a two week window in 26% of cases. Among individuals who were diagnosed with HIV infection at baseline, subsequent diagnoses of HCV infection was independently associated with: i) intravenous drug use (IDU) in males and females, Hazard Ratio (HR) = 6.64 (95% CI: 4.86-9.07) and 9.76 (95% CI: 5.76-16.54) respectively; ii) reported Aboriginal ethnicity in females HR = 2.09 (95% CI: 1.34-3.27) and iii) males not identified as men-who-have-sex-with-men (MSM), HR = 2.99 (95% CI: 2.09-4.27).Identification of HCV first compared to HIV first was independently associated with IDU in males and females OR = 2.83 (95% CI: 1.84-4.37) and 2.25 (95% CI: 1.15-4.39) respectively, but not Aboriginal ethnicity or MSM. HIV was identified first in 22%, with median time to HCV identification of 15 months;ConclusionThe ability to link BC public health and laboratory HIV and HCV information provided a unique opportunity to explore demographic and risk factors associated with HIV/HCV co-infection. Over half of persons with HIV infection who were tested for HCV were anti-HCV positive; half of these had HCV diagnosed first with HIV identification a median 3.5 years later. This highlights the importance of public health follow-up and harm reduction measures for people identified with HCV to prevent subsequent HIV infection.
Highlights
As HIV and hepatitis C (HCV) share some modes of transmission co-infection is not uncommon
A total of 6,288 HIV cases were eligible for analysis; 4,598 (73%) had personal identifiers and were potentially linkable to the combined HCV dataset
The high prevalence of co-infection supports the need for HCV screening in HIV positive populations
Summary
As HIV and hepatitis C (HCV) share some modes of transmission co-infection is not uncommon. HIV and hepatitis C (HCV) are major burdens on the health care system in Canada and share some common modes of transmission. HCV co-infection is estimated to occur in 20% of Canadians infected with HIV [1] and 5090% of HIV-positive persons who use drugs intravenously [2,3,4]. Compared to HIV mono-infected individuals, HIV/ HCV co-infected groups are characterized by a higher prevalence of injection drug use, poverty, and psychiatric disorders [5]. The rate of liver cirrhosis is up to six times higher in HIV coinfected persons than HCV mono-infected [12,16,17,18,19]. Effective anti-retroviral therapies have improved the life expectancy of persons with HIV so that persons coinfected with chronic HCV survive to develop HCV cirrhosis
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