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

• Published in: PloS one 2017-08, Vol.12 (8), p.e0183609-e0183609
• Main Authors: Butt, Zahid Ahmad, Shrestha, Nabin, Wong, Stanley, Kuo, Margot, Gesink, Dionne, Gilbert, Mark, Wong, Jason, Yu, Amanda, Alvarez, Maria, Samji, Hasina, Buxton, Jane A, Johnston, James C, Cook, Victoria J, Roth, David, Consolacion, Theodora, Murti, Michelle, Hottes, Travis S, Ogilvie, Gina, Balshaw, Robert, Tyndall, Mark W, Krajden, Mel, Janjua, Naveed Z
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Alcohol; Alcoholic beverages; Analysis; Biology and life sciences; British Columbia - epidemiology; Complications and side effects; Deprivation; Diagnosis; Disease control; Disease prevention; Drug abuse; Female; Health aspects; Health care; Health risks; Hepatitis; Hepatitis B; Hepatitis C; Hepatitis C - complications; Hepatitis C - epidemiology; Hepatitis C virus; HIV; HIV infections; HIV Infections - complications; HIV Infections - epidemiology; Human immunodeficiency virus; Humans; Illnesses; Infections; Male; Medical diagnosis; Medical laboratories; Medicine and health sciences; Mental disorders; Middle Aged; Mortality; Opioids; People and places; Physical Sciences; Population; Prevalence; Prevention; Public health; Regression analysis; Regression models; Social aspects; Social conditions; Socioeconomic Factors; Substance abuse; Substance use; Substance-Related Disorders - complications; Support services; Trends; Tuberculosis; Urban areas; Viruses; Young Adult
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0183609

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. 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, 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+. Of 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. These 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.