THE SYNDEMIC OF HEPATITIS CO-INFECTION AND SUBSTANCE USE AMONG PEOPLE LIVING WITH HIV: INSIGHTS FROM BALTIMORE AND BANGKOK
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Date
2020-04-24
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Johns Hopkins University
Abstract
The research presented in this dissertation explores the impact of hepatitis B virus (HBV) and hepatitis C virus (HCV) coinfection on the health of those living with HIV, and emphasizes the role substance use plays in the care of those with HIV/HCV.
The first paper explores barriers to HCV care in the interferon era and compares those who initiated treatment for HCV to those who did not in the Johns Hopkins HIV Clinical Cohort. Non-black and those with advanced fibrosis were more likely to have initiated HCV treatment, while those who reported active drug use or missed a higher proportion of clinic visits were less likely to have initiated treatment.
The second paper explores the relationship between HBV and/or HCV co-infection on mortality of those with HIV in early (1996-2001) and later (2002-2013) antiretroviral treatment (ART) eras. We conducted a survival analysis comparing HIV, HIV/HBV, HIV/HCV, and HIV/HBV/HCV patients. In this analysis, later ART substantially reduced mortality among HIV mono-infected individuals but not among all groups of coinfected patients, even after adjustment for age, CD4 count, and levels of HIV RNA suppression. Tenofovir and pegylated interferon did not significantly impact all-cause or liver-related mortality for coinfected patients.
The third paper documents increasing incidence of HCV among a Bangkok-based cohort of men who have sex with men (MSM) who were diagnosed with acute HIV. Previously, MSM were not considered to be at high risk for HCV infection in Thailand, and no incident HCV infections were identified between 2009-2014. However, since that time, HCV incidence has increased to 44.8 per 1000 PY in 2018. Methamphetamine use, group sex, and syphilis were associated with incident HCV.
Taken together, these papers highlight the impact of substance use on the likelihood that people living with HIV 1) acquire viral hepatitis and 2) receive treatment for co-infection. Additionally, it draws attention to persistently increased mortality rates among individuals co-infected with HIV and viral hepatitis despite the availability of treatment for HIV, HBV, and HCV. Interventions are needed to address factors underlying these disparities, and should focus on mitigating the effect of substance use disorder on engagement in clinical care.
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Keywords
HIV, Hepatitis C, Hepatitis B, substance use