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Impact of hepatitis B and C co-infection on health-related quality of life in HIV positive individuals

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Abstract

Purpose

Concurrent infection with HIV, hepatitis B virus (HBV), and hepatitis C virus (HCV) often occurs due to the commonality in risk factors for acquisition. Few studies have examined the effect of co-infection on health-related quality of life (HRQOL) in HIV positive individuals.

Methods

Ontario HIV Treatment Network Cohort Study (OCS) participants who completed an annual interviewer-administered questionnaire on up to three occasions were included. Generalized estimating equations (GEE) were used to assess the impact of HBV and HCV co-infection on physical and mental HRQOL component summary scores (range 0–100) as measured by the Medical Outcomes SF-36 health survey.

Results

As of March 2010, 1,223 participants had completed the questionnaire; 964 were HIV mono-infected, 128 were HIV–HBV co-infected, 112 were HIV–HCV co-infected, and 19 were HIV–HBV–HCV tri-infected. Eighty percent were male, median age 46 (IQR 40–53) years, 61 % Caucasian, median CD4 count 464 (IQR 319–636) cells/mm3, and 74 % had undetectable HIV viremia. Physical HRQOL was lower in HIV–HBV and HIV–HCV co-infected individuals (49.4 (IQR 42.0–53.9) and 48.1 (IQR 36.9–52.8) vs. 51.5 (IQR 45.0–55.4); p = 0.01 and <0.0001) compared to mono-infected individuals. In the multivariable GEE model, the negative impact of HCV remained significant (−2.18; p = 0.01) after adjusting for drug use, smoking, age, and gender. Unadjusted mental HRQOL was lower in HIV–HCV co-infected individuals (44.6 (IQR 34.6–54.0) vs. 48.9 (IQR 36.8–55.9); p = 0.03) compared to mono-infected individuals but no association of mental HRQOL with either co-infection was observed in multivariable GEE models.

Conclusions

HCV appears to negatively impact physical HRQOL suggesting a greater health burden for co-infected individuals. HBV and HCV co-infections were not related to lower mental HRQOL among people living with HIV/AIDS.

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Acknowledgments

We gratefully acknowledge all of the people living with HIV who volunteered to participate in the OHTN Cohort Study and the work and support of the past and present members of the OCS Governance Committee: Darien Taylor, Dr. Evan Collins, Dr. Greg Robinson, Shari Margolese, Patrick Cupido, Tony Di Pede, Rick Kennedy, Michael Hamilton, Ken King, Brian Finch, Lori Stoltz, Dr. Ahmed Bayoumi, Dr. Clemon George, Dr. Curtis Cooper, Dr. Troy Grennan, Adrian Betts, Tracey Conway, and Colleen Price. We thank all the interviewers, data collectors, research associates and coordinators, nurses, and physicians who provide support for data collection and extraction. The authors wish to thank the OHTN staff and their teams for data management and IT support (Mark Fisher, Director, IT), and OCS project coordination (Samantha Robinson, Project Coordinator). The OHTN Cohort Study is supported by the Ontario Ministry of Health and Long-Term Care. Five investigators are also the recipients of salary support from the Ontario HIV Treatment Network (JR, CC, TAH), and the Canadian Institutes of Health Research (SR, KO).

Conflict of interest

There are no conflicts of interest for any of the authors.

Author information

Authors and Affiliations

  1. Clinical Decision Making and Health Care, Toronto General Hospital, University Health Network, 200 Elizabeth St., Room 13EN226, Toronto, ON, M5G 2C4, Canada

    Jennifer Gillis & Janet Raboud

  2. The Ottawa Hospital Division of Infectious Diseases, University of Ottawa, Ottawa, ON, Canada

    Curtis Cooper

  3. Departments of Medicine and Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada

    Sean Rourke & Anita Rachlis

  4. Division of General Internal Medicine, Centre for Research on Inner City Health, The Keenan Research Centre in the Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, ON, Canada

    Sean Rourke

  5. Ontario HIV Treatment Network, Toronto, ON, Canada

    Sean Rourke & Sergio Rueda

  6. Department of Psychiatry, University of Toronto, Toronto, ON, Canada

    Sean Rourke, Sergio Rueda & Evan Collins

  7. School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada

    Kelly O’Brien

  8. Department of Physical Therapy, University of Toronto, Toronto, ON, Canada

    Kelly O’Brien

  9. Division of Infectious Diseases, Sunnybrook Health Sciences Centre, Toronto, ON, Canada

    Anita Rachlis

  10. Department of Psychology, Ryerson University, Toronto, ON, Canada

    Trevor A. Hart

  11. Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada

    Trevor A. Hart & Janet Raboud

  12. Immunodeficiency Clinic, Toronto General Hospital, University Health Network, Toronto, ON, Canada

    Evan Collins

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the OHTN Cohort Study Group

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Correspondence to Janet Raboud.

Appendix: The OHTN Cohort Study Team

Appendix: The OHTN Cohort Study Team

The OHTN Cohort Study Team consists of Dr. Sean B. Rourke (Principal Investigator, University of Toronto and OHTN), Dr. Ann Burchell (Co-Principal Investigator, OHTN), Dr. Sandra Gardner (OHTN), Dr. Sergio Rueda (OHTN), Dr. Ahmed Bayoumi, St. Michael’s Hospital; Dr. Jeffrey Cohen, Windsor Regional Hospital; Dr. Curtis Cooper, The Ottawa Hospital- General Campus; Dr. Don Kilby, University of Ottawa Health Services; Dr. Mona Loutfy and Dr. Fred Crouzat, Maple Leaf Medical Clinic; Dr. Anita Rachlis and Dr. Nicole Mittmann, Sunnybrook Health Sciences Centre; Dr. Janet Raboud and Dr. Irving Salit, Toronto General Hospital; Dr. Edward Ralph, St. Joseph’s Health Care; Dr. Roger Sandre, Sudbury Regional Hospital; Dr. Marek Smieja, Hamilton Health Sciences, McMaster University Medical Centre; and Dr. Wendy Wobeser, Hotel Dieu Hospital.

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Gillis, J., Cooper, C., Rourke, S. et al. Impact of hepatitis B and C co-infection on health-related quality of life in HIV positive individuals. Qual Life Res 22, 1525–1535 (2013). https://doi.org/10.1007/s11136-012-0283-7

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