The syndemic effect of HIV/HCV co-infection and mental health disorders on acute care hospitalization rate among people living with HIV/AIDS: a population-based retrospective cohort study

Canadian Journal of Public Health volume 110, pages779–791(2019)Cite this article

Abstract

Objective

Our primary objective was to examine the syndemic effect of HIV/HCV co-infection and mental health disorders (MHD) on the acute care hospitalization rate among people living with HIV (PLW-HIV) in British Columbia, Canada. Secondarily, we aimed to characterize the longitudinal trends in the aforementioned rate, while controlling for the effect of several factors.

Methods

In this retrospective cohort study, individuals were antiretroviral therapy-naïve, ≥ 18 years old, initiated treatment between 1 January 2000 and 31 December 2014, and were followed for at least 6 months until 31 December 2015 or last contact. The outcome was acute care hospitalization rate (every 6-month interval) per individual. The exposure was the interaction between HIV/HCV co-infection and MHD. Generalized non-linear mixed-effects models were built.

Results

Of the 4046 individuals in the final analytical sample, 1597 (39%) were PLW-HIV without MHD, 606 (15%) were people living with HIV and HCV (PLW-HIV/HCV) without MHD, 988 (24%) were PLW-HIV with MHD, and 855 (21%) were PLW-HIV/HCV with MHD. The adjusted rate ratios for acute care hospitalizations were 1.31 (95% [confidence interval] 1.13–1.52), 2.01 (95% CI 1.71–2.36), and 2.53 (95% CI 2.20–2.92) for PLW-HIV with MHD, PLW-HIV/HCV without MHD, and PLW-HIV/HCV with MHD, respectively, relative to PLW-HIV without MHD.

Conclusion

The HIV/HCV co-infection and MHD interaction demonstrated a significant effect on the rate of acute care hospitalization, particularly for PLW-HIV/HCV with MHD. Implementing widely accessible integrative care model best practices may address this public health challenge.

Résumé

Objectif

Notre principal objectif était d’examiner l’effet syndémique de la co-infection par le VIH et le VHC et des troubles mentaux (TM) sur le taux d’hospitalisation en soins de courte durée chez les personnes vivant avec le VIH (PVVIH) en Colombie-Britannique, au Canada. En second lieu, nous avons cherché à caractériser les tendances longitudinales du taux susmentionné, après avoir apporté des ajustements pour tenir compte des effets de plusieurs facteurs.

Méthode

Les sujets de cette étude de cohorte rétrospective étaient naïfs de traitement antirétroviral, avaient 18 ans ou plus, ont commencé un traitement entre le 1er janvier 2000 et le 31 décembre 2014 et ont été suivis pendant au moins 6 mois, jusqu’au 31 décembre 2015 ou au dernier contact. La résultante était le taux d’hospitalisation en soins de courte durée (à intervalles de 6 mois) par personne. L’exposition était l’interaction entre la co-infection par le VIH et le VHC et les TM. Nous avons construit des modèles non linéaires généralisés à effets mixtes.

Résultats

Sur les 4 046 sujets de l’échantillon d’analyse final, 1 597 (39 %) étaient des PVVIH sans TM, 606 (15 %) étaient des personnes vivant avec le VIH et le VHC (PVVIH-VHC) sans TM, 988 (24 %) étaient des PVVIH avec TM, et 855 (21 %) étaient des PVVIH-VHC avec TM. Les rapports de taux ajustés pour les hospitalisations en soins de courte durée étaient de 1,31 (IC de 95 % (1,13-1,52), de 2,01 (IC de 95 % 1,71-2,36) et de 2,53 (IC de 95 % 2,20-2,92) pour les PVVIH avec TM, les PVVIH-VHC sans TM et les PVVIH-VHC avec TM, respectivement, comparativement aux PVVIH sans TM.

Conclusion

L’interaction entre la co-infection par le VIH et le VHC et les TM exerce un effet significatif sur le taux d’hospitalisation en soins de courte durée, particulièrement chez les personnes vivant avec le VIH et le VHC et ayant des troubles mentaux. La mise en œuvre de modèles de soins intégrés exemplaires largement accessibles pourrait contribuer à résoudre ce problème de santé publique.

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Funding

This work was supported by the following sources of funding: JSGM’s Treatment as Prevention (TasP) research, paid to his institution, has received support from the Public Health Agency of Canada, the British Columbia Ministry of Health, and the US National Institutes of Health (R01DA036307 and CTN 248). VDL is funded by a grant from the Canadian Institutes of Health Research (PJT-148595), by a Scholar Award from the Michael Smith Foundation for Health Research and a New Investigator award from the Canadian Institutes of Health Research. The sponsors had no role in the design, data collection, data analysis, data interpretation, or writing of the report.

Author information

Affiliations

  1. British Columbia Centre for Excellence in HIV/AIDS, Room 608, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada

    Martin St-Jean, Hiwot Tafessu, Kalysha Closson, Mark W. Hull, Robert S. Hogg, Rolando Barrios, Julio S.G. Montaner & Viviane D. Lima

  2. School of Population and Public Health, University of British Columbia, Vancouver, Canada

    Kalysha Closson, Lianping Ti & Jean A. Shoveller

  3. Department of Psychiatry, University of California at San Diego, San Diego, CA, USA

    Thomas L. Patterson

  4. Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada

    M. Ruth Lavergne & Robert S. Hogg

  5. Department of Psychiatry, University of British Columbia, Vancouver, Canada

    Julius Elefante

  6. Division of Infectious Diseases, Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, Canada

    Mark W. Hull, Julio S.G. Montaner & Viviane D. Lima

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  1. Martin St-Jean
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Correspondence to Viviane D. Lima.

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Conflict of interest

JSGM has received institutional grants from Gilead Sciences, J&J, Merck, ViiV Healthcare, and a Knowledge Translation Award from the Canadian Institutes of Health Research. JSGM has also served as an advisor to the Government of Canada and the Government of British Columbia in the last year. All other authors declare no competing interests.

Ethics approval

The BC-CfE received approval for this study from the University of British Columbia Ethics Review Committee at the St. Paul’s Hospital, Providence Health Care site (H18-02208; H16-02036).

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St-Jean, M., Tafessu, H., Closson, K. et al. The syndemic effect of HIV/HCV co-infection and mental health disorders on acute care hospitalization rate among people living with HIV/AIDS: a population-based retrospective cohort study. Can J Public Health 110, 779–791 (2019). https://doi.org/10.17269/s41997-019-00253-w

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Keywords

  • HIV
  • Hepatitis C virus
  • Co-infection
  • Mental health
  • Inpatients
  • Public health

Mots-clés

  • VIH
  • Virus de l’hépatite C
  • Co-infection
  • Santé mentale
  • Patients hospitalisés
  • Santé publique