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Kyaw NTT, Satyanarayana S, Harries AD, Kumar AMV, Kyaw KWY, Phyo KH, Hayat MJ, Castro KG, Magee MJ. Increased All-cause Mortality in People With HIV and Comorbidities: Hepatitis B and C Virus Seropositivity and Hyperglycemia in Myanmar, 2005-2017. Open Forum Infect Dis 2022; 10:ofac672. [PMID: 36632421 PMCID: PMC9830546 DOI: 10.1093/ofid/ofac672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Accepted: 12/12/2022] [Indexed: 12/15/2022] Open
Abstract
Background Hepatitis C virus (HCV) and hepatitis B virus (HBV) coinfection are associated with increased mortality in people with HIV (PWH), and hyperglycemia is a common comorbidity in PWH. In this study, we used routinely collected clinical data to assess the associations between HBV and HCV seropositivity with all-cause mortality and whether this relationship differs by hyperglycemia status. Methods Eligible participants included adult PWH (≥15 years) who initiated antiretroviral therapy between May 2005 and June 2016 in Myanmar. HBV and HCV serostatus and hyperglycemia were measured at enrollment to HIV care using HBV surface antigen, HCV antibody tests, and random blood glucose (≥140 mg/dL), respectively. Results Among 27 722 PWH, 2260 (8%) were HBV seropositive, 2265 (9%) were HCV seropositive, 178 (0.6%) were HBV-HCV seropositive, and 1425 (5%) had hyperglycemia. During the median follow-up (interquartile range) of 3.1 (1.5-5.1) years, 3655 (13%) PWH died, and the overall mortality rate was 3.8 (95% CI, 3.7-3.9) per 100-person-years (PY). The mortality rate (per 100 PY) among PWH who were HBV seropositive was 4.6, among PWH who were HCV seropositive it was 5.1, and among PWH who were HBV-HCV seropositive it was 7.1. When stratified by glycemic status, the mortality rate was higher among patients with hyperglycemia compared with those with euglycemia (5.4 vs 4.0 per 100 PY), and the difference in mortality rate between patients with hyperglycemia and euglycemia was highest among those with HCV seropositivity (9.8 vs 5.0 per 100 PY). Conclusions Increased mortality rates associated with HBV and HCV seropositivity in PWH differed by their glycemic status. PWH with HCV seropositivity and hyperglycemia had the highest mortality rates.
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Affiliation(s)
- Nang Thu Thu Kyaw
- Correspondence: Nang Thu Thu Kyaw, MBBS, MPH, International Union Against Tuberculosis & Lung Disease, No 36, 27th Street, between 72nd & 73rd Street, Mandalay, Myanmar ()
| | - Srinath Satyanarayana
- International Union Against Tuberculosis and Lung Disease, The Union South-East Asia Office, New Delhi, India
- International Union Against Tuberculosis and Lung Disease, Paris, France
| | - Anthony D Harries
- International Union Against Tuberculosis and Lung Disease, Paris, France
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Ajay M V Kumar
- International Union Against Tuberculosis and Lung Disease, Paris, France
- Yenepoya Medical College, Yenepoya (Deemed to be University), Mangaluru, India
| | - Khine Wut Yee Kyaw
- International Union Against Tuberculosis and Lung Disease, The Union Myanmar Office, Mandalay, Myanmar
| | - Khaing Hnin Phyo
- International Union Against Tuberculosis and Lung Disease, The Union Myanmar Office, Mandalay, Myanmar
| | - Matthew J Hayat
- Division of Epidemiology and Biostatistics, School of Public Health, Georgia State University, Atlanta, Georgia, USA
| | - Kenneth G Castro
- Hubert Department of Global Health and Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
- Division of Infectious Diseases, Department of Medicine, School of Medicine, Emory University, Atlanta, Georgia, USA
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A Cross-Sectional Analysis of Tobacco Use and Concurrent Alcohol and Substance Use Among Patients Living with HIV/HCV Co-infection: Findings from a Large Urban Tertiary Center. J Clin Psychol Med Settings 2020; 28:553-561. [PMID: 33001329 PMCID: PMC7528154 DOI: 10.1007/s10880-020-09744-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/23/2020] [Indexed: 01/29/2023]
Abstract
This study aimed to assess the prevalence of and factors associated with tobacco use among patients living with HIV/HCV co-infection. Patient reported outcomes (PROs) were analyzed of patients living with HIV/HCV co-infection (n = 313) who presented for clinical evaluation and treatment of HCV between 2013 and 2017 at a university-affiliated HIV/HCV Co-infection Clinic. The prevalence of tobacco use in patients living with HIV/HCV co-infection was 48%. Compared to non-smokers, a higher proportion of tobacco smokers had substance use disorders and concurrent alcohol and substance use. In the multivariate analysis, concurrent alcohol and substance use was positively associated with tobacco use. The findings suggest clinical interventions are urgently needed to reduce tobacco use among patients living with HIV/HCV co-infection—a doubly-vulnerable immunocompromised population. Otherwise, failed efforts to dedicate resources and targeted behavioral interventions for this respective population will inhibit survival—especially considering the recent and evolving COVID-19 pandemic.
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Sims OT, Chiu CY, Chandler R, Melton P, Wang K, Richey C, Odlum M. Alcohol Use and Ethnicity Independently Predict Antiretroviral Therapy Nonadherence Among Patients Living with HIV/HCV Coinfection. J Racial Ethn Health Disparities 2019; 7:28-35. [PMID: 31435855 DOI: 10.1007/s40615-019-00630-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 08/06/2019] [Accepted: 08/12/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Adherence to antiretroviral therapy (ART) is important to counter synergistic effects of HIV and hepatitis C (HCV) in patients living with coinfection. Predictors of ART nonadherence among patients living with HIV/HCV coinfection are not well established. This knowledge would be advantageous for clinicians and behavioral health specialists who provide care to patients living with HIV/HCV coinfection. OBJECTIVES The purpose of this study was to assess prevalence and predictors of ART nonadherence in a sample of patients living with HIV/HCV coinfection who were actively in HIV clinical care. METHOD A sample of patients living with HIV/HCV coinfection who received care at a university-affiliated HIV clinic (n = 137) between January 2013 and July 2017 were included in the study. Computerized patient-reported data or outcomes (PROs) and electronic medical record data of these respective patients were collected and analyzed. Binomial logistic regression was used to examine predictors of ART nonadherence. RESULTS The prevalence of ART nonadherence was 31%. In multivariate analysis, African American ethnicity (OR = 3.28, CI 1.241-8.653, p = 0.017) and a higher number of alcoholic drinks per drinking day (OR = 1.31, CI 1.054-1.639, p = 0.015) were positively associated with ART nonadherence. CONCLUSIONS Behavioral health providers are encouraged to incorporate alcohol use reduce interventions in HIV clinical settings to reduce ART nonadherence among patients living with HIV/HCV coinfection. Additionally, public health professionals and researchers, and clinicians are encouraged to use inductive methods to discover why ART nonadherence disproportionately impacts African American patients living with HIV/HCV coinfection and to develop approaches that are sensitive to those respective barriers.
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Affiliation(s)
- Omar T Sims
- Department of Social Work, College of Arts and Sciences, University of Alabama at Birmingham, Birmingham, AL, USA.
- Department of Health Behavior, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA.
- Comprehensive Center for Healthy Aging, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
- Center for AIDS Research, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
- Center for AIDS Prevention Studies, Division of Prevention Science, Department of Medicine, University of California, San Franciso, CA, USA.
- The University of Alabama at Birmingham, Univesity Hall 3137, 1720 2nd AVE S, Birmingham, AL, 35294-1260, USA.
| | - Chia-Ying Chiu
- Department of Health Behavior, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Rasheeta Chandler
- Center for AIDS Prevention Studies, Division of Prevention Science, Department of Medicine, University of California, San Franciso, CA, USA
- School of Nursing, Emory University, Atlanta, GA, USA
| | - Pamela Melton
- Department of Social Work, College of Education, Humanities, and Behavioral Sciences, Alabama A&M University, 104 Bibb Graves Hall, Normal, AL, USA
| | - Kaiying Wang
- Department of Health Behavior, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Caroline Richey
- Department of Social Work, College of Arts and Sciences, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Michelle Odlum
- School of Nursing, Columbia University, 560 West 168th Street, New York, 10032, USA
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HIV and viral hepatitis coinfection analysis using surveillance data from 15 US states and two cities. Epidemiol Infect 2018; 146:920-930. [PMID: 29636119 DOI: 10.1017/s0950268818000766] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Coinfection with human immunodeficiency virus (HIV) and viral hepatitis is associated with high morbidity and mortality in the absence of clinical management, making identification of these cases crucial. We examined characteristics of HIV and viral hepatitis coinfections by using surveillance data from 15 US states and two cities. Each jurisdiction used an automated deterministic matching method to link surveillance data for persons with reported acute and chronic hepatitis B virus (HBV) or hepatitis C virus (HCV) infections, to persons reported with HIV infection. Of the 504 398 persons living with diagnosed HIV infection at the end of 2014, 2.0% were coinfected with HBV and 6.7% were coinfected with HCV. Of the 269 884 persons ever reported with HBV, 5.2% were reported with HIV. Of the 1 093 050 persons ever reported with HCV, 4.3% were reported with HIV. A greater proportion of persons coinfected with HIV and HBV were males and blacks/African Americans, compared with those with HIV monoinfection. Persons who inject drugs represented a greater proportion of those coinfected with HIV and HCV, compared with those with HIV monoinfection. Matching HIV and viral hepatitis surveillance data highlights epidemiological characteristics of persons coinfected and can be used to routinely monitor health status and guide state and national public health interventions.
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Velen K, Charalambous S, Innes C, Churchyard GJ, Hoffmann CJ. Chronic hepatitis B increases mortality and complexity among HIV-coinfected patients in South Africa: a cohort study. HIV Med 2016; 17:702-7. [PMID: 26991340 PMCID: PMC6717432 DOI: 10.1111/hiv.12367] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/18/2015] [Indexed: 12/13/2022]
Abstract
OBJECTIVES To assess the effect of chronic hepatitis B on survival and clinical complexity among people living with HIV following antiretroviral therapy (ART) initiation. METHODS We evaluated mortality and single-drug substitutions up to 3 years from ART initiation (median follow-up 2.75 years; interquartile range 2-3 years) among patients with and without chronic hepatitis B (CHB) enrolled in a workplace HIV care programme in South Africa. RESULTS Mortality was increased for CHB patients with hepatitis B virus (HBV) DNA levels > 10 000 copies/mL (adjusted hazard ratio 3.1; 95% confidence interval 1.2-8.0) compared with non-CHB patients. We did not observe a similar difference between non-CHB patients and those with CHB and HBV DNA < 10 000 copies/mL (adjusted hazard ratio 0.70; 95% confidence interval 0.2-2.3). Single-drug substitutions occurred more frequently among coinfected patients regardless of HBV DNA level. CONCLUSIONS Our findings suggest that CHB may increase mortality and complicate ART management.
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Affiliation(s)
| | - Salome Charalambous
- The Aurum Institute, Johannesburg, South Africa
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Craig Innes
- The Aurum Institute, Johannesburg, South Africa
| | - Gavin J Churchyard
- The Aurum Institute, Johannesburg, South Africa
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Christopher J Hoffmann
- The Aurum Institute, Johannesburg, South Africa
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
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Stabinski L, OʼConnor S, Barnhart M, Kahn RJ, Hamm TE. Prevalence of HIV and hepatitis B virus co-infection in sub-Saharan Africa and the potential impact and program feasibility of hepatitis B surface antigen screening in resource-limited settings. J Acquir Immune Defic Syndr 2015; 68 Suppl 3:S274-85. [PMID: 25768867 PMCID: PMC10426262 DOI: 10.1097/qai.0000000000000496] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Screening people living with HIV for hepatitis B virus (HBV) co-infection is recommended in resource-rich settings to optimize HIV antiretroviral therapy (ART) and mitigate HBV-related liver disease. This review examines the need, feasibility, and impact of screening for HBV in resource-limited settings (RLS). METHODS We searched 6 databases to identify peer-reviewed publications between 2007 and 2013 addressing (1) HIV/HBV co-infection frequency in sub-Saharan Africa (SSA); (2) performance of hepatitis B surface antigen (HBsAg) rapid strip assays (RSAs) in RLS; (3) impact of HBV co-infection on morbidity, mortality, or liver disease progression; and/or (4) impact of HBV-suppressive antiretroviral medications as part of ART on at least one of 5 outcomes (mortality, morbidity, HIV transmission, retention in HIV care, or quality of life). We rated the quality of individual articles and summarized the body of evidence and expected impact of each intervention per outcome addressed. RESULTS Of 3940 identified studies, 85 were included in the review: 55 addressed HIV/HBV co-infection frequency; 6 described HBsAg RSA performance; and 24 addressed the impact of HIV/HBV co-infection and ART. HIV/HBV frequency in sub-Saharan Africa varied from 0% to >28.4%. RSA performance in RLS showed good, although variable, sensitivity and specificity. Quality of studies ranged from strong to weak. Overall quality of evidence for the impact of HIV/HBV co-infection and ART on morbidity and mortality was fair and good to fair, respectively. CONCLUSIONS Combined, the body of evidence reviewed suggests that HBsAg screening among people living with HIV could have substantial impact on preventing morbidity and mortality among HIV/HBV co-infected individuals in RLS.
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Affiliation(s)
- Lara Stabinski
- *United States Department of State, Office of the US Global AIDS Coordinator and Health Diplomacy, Washington, DC; †Division of Viral Hepatitis, National Center for HIV/AIDS, STD, and TB Prevention, US Centers for Disease Control and Prevention, Atlanta, GA; ‡Office of HIV and AIDS, Bureau for Global Health, United States Agency for International Development, Washington, DC; §US Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD; and ‖The Henry M. Jackson Foundation for the Advancement of Military Medicine Inc., Bethesda, MD
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Kruse R, Kramer JR, Tyson GL, Duan Z, Chen L, El-Serag HB, Kanwal F. Clinical outcomes of hepatitis B virus coinfection in a United States cohort of hepatitis C virus-infected patients. Hepatology 2014; 60:1871-8. [PMID: 25065513 PMCID: PMC4245372 DOI: 10.1002/hep.27337] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2014] [Accepted: 07/24/2014] [Indexed: 12/19/2022]
Abstract
UNLABELLED The effect of hepatitis B virus (HBV) coinfection in patients with hepatitis C virus (HCV) remains unclear. We used the National Veterans Affairs HCV Clinical Case Registry to identify patients with confirmed HCV viremia during 1997-2005. We defined HBV coinfection as a positive test for hepatitis B surface antigen, HBV DNA, or hepatitis B e antigen. We defined cirrhosis and hepatocellular carcinoma (HCC) based on the validated ICD-9 codes and determined mortality through the end of 2009. We performed Cox proportional hazard regression analyses to examine the effect of HBV coinfection stratified by HBV DNA status (positive or negative) on the risk of cirrhosis, HCC, and death adjusting for patients' age, gender, race, human immunodeficiency virus (HIV) infection, alcohol or drug use, Deyo Score, and antiviral treatment. Among 99,548 patients with HCV infection, 1,370 patients (1.4%) had HBV coinfection. Of the coinfected patients, 677 (49.4%) patients had at least one HBV DNA test done and 303 patients (44.7%) tested positive for HBV DNA. The incidence rates of cirrhosis, HCC, and death were significantly higher in patients with HBV coinfection and detectable HBV DNA compared to HCV monoinfection (36.8, 6.9, and 41.7 versus 17.4, 3.6, and 31.4 per 1,000 person-years, respectively; P < 0.05 for all comparisons). After adjustment for demographic, clinical, and treatment factors, patients with detectable HBV DNA had a significantly higher risk for cirrhosis (hazard ratio [HR] = 1.89 95% confidence interval [CI] = 1.46-2.45), HCC (HR = 2.12, 95% CI = 1.26-3.60), and death (HR = 1.62, 95% CI = 1.33-1.99) compared to HCV monoinfected patients. There were no differences in the risk of cirrhosis, HCC, or overall mortality between coinfected patients with undetectable HBV DNA and those with HCV monoinfection (HR = 1.18, 95% CI = 0.90-1.55; 1.54, 95% CI = 0.93-2.56; 1.08, 95% CI = 0.88-1.33, respectively). CONCLUSION We found that while only a small number of HCV patients were coinfected with HBV, patients with documented HBV viremia were at a significantly higher risk for cirrhosis, HCC, and overall death than HCV monoinfected patients. Absence of HBV replication was associated with a clinical course similar to that of HCV monoinfected patients.
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Affiliation(s)
- Robert Kruse
- Interdepartmental Program in Translational Biology and Molecular Medicine,
Baylor College of Medicine, Houston, Texas
| | - Jennifer R. Kramer
- Center for Innovations in Quality, Effectiveness, and Safety (IQuESt),
Michael E. DeBakey Veterans Affairs Medical Center
| | - Gia L. Tyson
- Center for Innovations in Quality, Effectiveness, and Safety (IQuESt),
Michael E. DeBakey Veterans Affairs Medical Center,Section of Gastroenterology and Hepatology, Department of Medicine, Baylor
College of Medicine, Houston, TX,Section of Health Services Research, Department of Medicine, Baylor College
of Medicine, Houston, TX
| | - Zhigang Duan
- Center for Innovations in Quality, Effectiveness, and Safety (IQuESt),
Michael E. DeBakey Veterans Affairs Medical Center,Section of Health Services Research, Department of Medicine, Baylor College
of Medicine, Houston, TX
| | - Liang Chen
- Center for Innovations in Quality, Effectiveness, and Safety (IQuESt),
Michael E. DeBakey Veterans Affairs Medical Center,Section of Health Services Research, Department of Medicine, Baylor College
of Medicine, Houston, TX
| | - Hashem B. El-Serag
- Center for Innovations in Quality, Effectiveness, and Safety (IQuESt),
Michael E. DeBakey Veterans Affairs Medical Center,Section of Gastroenterology and Hepatology, Department of Medicine, Baylor
College of Medicine, Houston, TX,Section of Health Services Research, Department of Medicine, Baylor College
of Medicine, Houston, TX
| | - Fasiha Kanwal
- Center for Innovations in Quality, Effectiveness, and Safety (IQuESt),
Michael E. DeBakey Veterans Affairs Medical Center,Section of Gastroenterology and Hepatology, Department of Medicine, Baylor
College of Medicine, Houston, TX,Section of Health Services Research, Department of Medicine, Baylor College
of Medicine, Houston, TX,Interdepartmental Program in Translational Biology and Molecular Medicine,
Baylor College of Medicine, Houston, Texas
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HIV and viral hepatitis co-infection in New York City, 2000-2010: prevalence and case characteristics. Epidemiol Infect 2014; 143:1408-16. [PMID: 25170631 DOI: 10.1017/s0950268814002209] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Using surveillance data, we describe the prevalence and characteristics of individuals in New York City (NYC) co-infected with human immunodeficiency virus (HIV) and hepatitis B virus (HBV) and/or hepatitis C virus (HCV). Surveillance databases including persons reported to the NYC Department of Health and Mental Hygiene with HIV, HBV, and HCV by 31 December 2010 and not known to be dead as of 1 January 2000, were matched with 2000-2011 vital statistics mortality data. Of 140 606 persons reported with HIV, 4% were co-infected with HBV only, 15% were co-infected with HCV only, and 1% were co-infected with HBV and HCV. In all groups, 70-80% were male. The most common race/ethnicity and HIV transmission risk groups were non-Hispanic blacks and men who have sex with men (MSM) for HIV/HBV infection, and non-Hispanic blacks, Hispanics, and injection drug users for HIV/HCV and HIV/HBV/HCV infections. The overall age-adjusted 2000-2011 mortality was higher in co-infected than HIV mono-infected individuals. Use of population-based surveillance data provided a comprehensive characterization of HIV co-infection with HBV and HCV. Our findings emphasize the importance of targeting HIV and viral hepatitis testing and prevention efforts to populations at risk for co-infection, and of integrating HIV and viral hepatitis care and testing services.
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