Abstract
BackgroundThe burden of HCV among those living with HIV remains a major public health challenge. We aimed to characterize trends in healthcare-related visits (HRV) of people living with HIV (PLW-HIV) and those living with HIV and HCV (PLW-HIV/HCV), in British Columbia (BC), and to identify risk factors associated with the highest HRV rates over time.MethodsEligible individuals, recruited from the BC Seek and Treat for Optimal Prevention of HIV/AIDS population-based retrospective cohort (N = 3955), were ≥ 18 years old, first started combination antiretroviral therapy (ART) between 01/01/2000–31/12/2013, and were followed for ≥6 months until 31/12/2014. The main outcome was HRV rate. The main exposure was HIV/HCV co-infection status. We built a confounder non-linear mixed effects model, adjusting for several demographic and time-dependent factors.ResultsHRV rates have decreased since 2000 in both groups. The overall age-sex standardized HRV rate (per person-year) among PLW-HIV and PLW-HIV/HCV was 21.11 (95% CI 20.96–21.25) and 41.69 (95% CI 41.51–41.88), respectively. The excess in HRV in the co-infected group was associated with late presentation for ART, history of injection drug use, sub-optimal ART adherence and a higher number of comorbidities. The adjusted HRV rate ratio for PLW-HIV/HCV in comparison to PLW-HIV was 1.18 (95% CI 1.13–1.24).ConclusionsAlthough HRV rates have decreased over time in both groups, PLW-HIV/HCV had 18% higher HRV than those only living with HIV. Our results highlight several modifiable risk factors that could be targeted as potential means to minimize the disease burden of this population and of the healthcare system.
Highlights
The burden of hepatitis C virus (HCV) among those living with HIV remains a major public health challenge
People living with HIV/AIDS (PLW-HIV) have life expectancies comparable to those observed in the general
We aimed at identifying modifiable risk factors, associated with the highest healthcare-related visits (HRV) rates over time that could be targeted as potential means to minimize the disease burden of this population and on the healthcare system
Summary
The burden of HCV among those living with HIV remains a major public health challenge. HIV/AIDS associated morbidity and mortality has decreased to unprecedented levels, largely due to the widespread use of combination antiretroviral therapy (ART) [2]. The hepatitis C virus (HCV) has become one of the most prevalent co-infection among PLW-HIV [5]. In Canada, similar to the United States, 20% to 30% of PLW-HIV are living with HCV, while the prevalence of both viruses among PWID ranges between 50% and 90% [7,8,9]. The presence of both viruses has been shown to increase the risk for clinical progression of HIV as well as premature mortality (despite ART), and accelerated progression of HCV-associated liver diseases [10, 11]
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