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

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.研究背景：社会状况与感染的共现特征，可能会影响人类免疫缺陷病毒（Human Immunodeficiency Virus, HIV）与丙型肝炎病毒（Hepatitis C Virus, HCV）的患病风险及疾病进展。本研究聚焦1990年至2013年不列颠哥伦比亚省（British Columbia）的人群数据，考察了此类社会状况与感染的关联随时间推移对HIV及HCV感染的影响变化。 研究方法：不列颠哥伦比亚省丙型肝炎检测队列（BC Hepatitis Testers Cohort，缩写BC-HTC）纳入了约150万名接受过HIV或HCV检测，或被报告为HCV、HIV、乙型肝炎病毒（Hepatitis B Virus, HBV）或结核病病例的个体，其数据关联于行政医疗数据库。本研究将HCV与HIV的感染状态划分为五种组合：HIV-/HCV-双阴性、HIV+单感染、HIV-/HCV+血清转换者、HIV-/HCV+现症感染者、HIV+/HCV+共感染者。 研究结果：在137万名符合纳入标准的个体中，4.1%为HIV-/HCV+现症感染者，0.5%为HIV+单感染者，0.3%为HIV+/HCV+共感染者，另有0.5%为HIV-/HCV+血清转换者。总体而言，HIV+单感染者多居住于城市地区（92%），注射吸毒（injection drug use, IDU）比例较低（4%），存在问题性饮酒行为的比例为4%，且物质生活条件较其他群组更为优渥。HIV+/HCV+共感染者与HIV-/HCV+血清转换者的物质匮乏程度最高（分别为37%、32%），注射吸毒比例更高（28%、49%），问题性饮酒比例分别为14%、17%，且重性精神疾病患病率更高（12%、21%）。随时间推移，HIV-/HCV+血清转换者的注射吸毒、阿片类药物替代治疗（opioid substitution therapy）及物质匮乏情况均有所增加。在多变量多项Logistic回归模型中，随时间推移，HIV-/HCV+现症感染者与HIV+单感染者的注射吸毒发生比有所下降，但HIV-/HCV+血清转换者未出现此类变化。此外，HIV-/HCV+血清转换者与共感染者的问题性饮酒发生比随时间推移均有所下降。 研究结论：本研究结果提示，需针对不同群组间存在差异且随时间动态演变的感染与社会状况共现综合征（syndemics），为HIV及HCV感染人群制定预防、诊疗与支持服务方案。