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

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.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2

References

  1. BC Stats. (2017). Population estimates. http://www.bcstats.gov.bc.ca/StatisticsBySubject/Demography/PopulationEstimates.aspx. Accessed 27 February 2017.

  2. Blank, M. B., Himelhoch, S., Walkup, J., & Eisenberg, M. M. (2013). Treatment considerations for HIV-infected individuals with severe mental illness. Current HIV/AIDS Reports, 10(4), 371–379. https://doi.org/10.1007/s11904-013-0179-3.

    Article  PubMed  Google Scholar 

  3. British Columbia Centre for Excellence in HIV/AIDS. (2018). Therapeutic guidelines: antiretroviral treatment of adult HIV infection. http://cfenet.ubc.ca/sites/default/files/uploads/Guidelines/Therapeutic-Guidelines-for-Antiretroviral-ARV-Treatment-of-Adult-HIV-Infection-[29-MAY-2018].pdf. Accessed 05 June 2018.

  4. British Columbia College of Family Physicians. (2018). Mental health and addictions strategy development https://bccfp.bc.ca/wp-content/uploads/2019/01/BCCFP-Mental-Health-and-Addictions-Strategy-Development.pdf. Accessed 23 April 2019.

  5. British Columbia Ministry of Health. (2018). Adults with chronic hepatitis C: PharmaCare expanded coverage for adults with chronic hepatitis C infection. https://www2.gov.bc.ca/assets/gov/health/health-drug-coverage/pharmacare/chc_expanded_coverage.pdf. Accessed 25 July 2018.

  6. Brooks, M. E., Kristensen, K., van Benthem, K. J., Magnusson, A., Berg, C. W., Nielsen, A., et al. (2017). glmmTMB balances speed and flexibility among packages for zero-inflated generalized linear mixed modeling. The R Journal, 9(2), 378–400.

    Article  Google Scholar 

  7. Buxton, J. A., Yu, A., Kim, P. H., Spinelli, J. J., Kuo, M., Alvarez, M., et al. (2010). HCV co-infection in HIV positive population in British Columbia, Canada. BMC Public Health, 10, 225. https://doi.org/10.1186/1471-2458-10-225.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Deeks, S. G., Lewin, S. R., & Havlir, D. V. (2013). The end of AIDS: HIV infection as a chronic disease. Lancet, 382(9903), 1525–1533. https://doi.org/10.1016/S0140-6736(13)61809-7.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Green, T., Flash, S., & Reiss, A. L. (2018). Sex differences in psychiatric disorders: what we can learn from sex chromosome aneuploidies. Neuropsychopharmacology. https://doi.org/10.1038/s41386-018-0153-2.

    Article  Google Scholar 

  10. Hall, J., & Sammons, P. (2013). Mediation, moderation & interaction. In T. Teo (Ed.), Handbook of quantitative methods for educational research (pp. 267–286). Rotterdam: SensePublishers.

    Google Scholar 

  11. Heath, K., Samji, H., Nosyk, B., Colley, G., Gilbert, M., Hogg, R. S., et al. (2014). Cohort profile: seek and treat for the optimal prevention of HIV/AIDS in British Columbia (STOP HIV/AIDS BC). International Journal of Epidemiology, 43(4), 1073–1081. https://doi.org/10.1093/ije/dyu070.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Hughes, E., Bassi, S., Gilbody, S., Bland, M., & Martin, F. (2016). Prevalence of HIV, hepatitis B, and hepatitis C in people with severe mental illness: a systematic review and meta-analysis. Lancet Psychiatry, 3(1), 40–48. https://doi.org/10.1016/S2215-0366(15)00357-0.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Ingiliz, P., & Rockstroh, J. K. (2015). Natural history of liver disease and effect of hepatitis C virus on HIV disease progression. Current Opinion in HIV and AIDS, 10(5), 303–308. https://doi.org/10.1097/COH.0000000000000187.

    CAS  Article  PubMed  Google Scholar 

  14. Janjua, N. Z., Kuo, M., Yu, A., Alvarez, M., Wong, S., Cook, D., et al. (2016). The population level cascade of care for hepatitis C in British Columbia, Canada: the BC Hepatitis Testers Cohort (BC-HTC). EBioMedicine, 12, 189–195. https://doi.org/10.1016/j.ebiom.2016.08.035.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Jeal, B. (2015). Welcome home: impact and effectiveness of the Dr. Peter Centre’s harm reduction model for those living with HIV/AIDS and who use illicit drugs: part of the mixed method study titled: a mixed method evaluation of the impact of the Dr. Peter Centre on health care access and outcomes for persons living with HIV/AIDS.

  16. Katrak, S., Park, L. P., Woods, C., Muir, A., Hicks, C., & Naggie, S. (2016). Patterns of healthcare utilization among veterans infected with hepatitis C virus (HCV) and human immunodeficiency virus (HIV) and coinfected with HIV/HCV: unique burdens of disease. Open Forum Infectious Diseases, 3(3), ofw173. https://doi.org/10.1093/ofid/ofw173.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Lima, V. D., Geller, J., Bangsberg, D. R., Patterson, T. L., Daniel, M., Kerr, T., et al. (2007). The effect of adherence on the association between depressive symptoms and mortality among HIV-infected individuals first initiating HAART. AIDS, 21(9), 1175–1183. https://doi.org/10.1097/QAD.0b013e32811ebf57.

    Article  PubMed  Google Scholar 

  18. Lima, V. D., Bangsberg, D. R., Harrigan, P. R., Deeks, S. G., Yip, B., Hogg, R. S., et al. (2010). Risk of viral failure declines with duration of suppression on highly active antiretroviral therapy irrespective of adherence level. Journal of Acquired Immune Deficiency Syndromes, 55(4), 460–465. https://doi.org/10.1097/QAI.0b013e3181f2ac87.

    CAS  Article  PubMed  Google Scholar 

  19. Lima, V. D., Eyawo, O., Ma, H., Lourenco, L., Chau, W., Hogg, R. S., et al. (2015a). The impact of scaling-up combination antiretroviral therapy on patterns of mortality among HIV-positive persons in British Columbia, Canada. Journal of the International AIDS Society, 18, 20261. https://doi.org/10.7448/IAS.18.1.20261.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  20. Lima, V. D., Reuter, A., Harrigan, P. R., Lourenco, L., Chau, W., Hull, M., et al. (2015b). Initiation of antiretroviral therapy at high CD4+ cell counts is associated with positive treatment outcomes. AIDS, 29(14), 1871–1882. https://doi.org/10.1097/QAD.0000000000000790.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  21. Maldonado, G., & Greenland, S. (1993). Simulation study of confounder-selection strategies. American Journal of Epidemiology, 138(11), 923–936.

    CAS  Article  Google Scholar 

  22. Marcus, J. L., Leyden, W. A., Chao, C. R., Xu, L., Quesenberry, C. P., Jr., Tien, P. C., et al. (2015). Differences in response to antiretroviral therapy by sex and hepatitis C infection status. AIDS Patient Care and STDs, 29(7), 370–378. https://doi.org/10.1089/apc.2015.0040.

    Article  PubMed  PubMed Central  Google Scholar 

  23. McDonald, J. H. (2009). In S. H. P. Baltimore (Ed.), Handbook of biological statistics (2nd Edition ed.).

    Google Scholar 

  24. Olding, M., Enns, B., Panagiotoglou, D., Shoveller, J., Harrigan, P. R., Barrios, R., et al. (2017). A historical review of HIV prevention and care initiatives in British Columbia, Canada: 1996-2015. Journal of the International AIDS Society, 20(1), 21941. https://doi.org/10.7448/IAS.20.1.21941.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Pence, B. W., Miller, W. C., Gaynes, B. N., & Eron, J. J., Jr. (2007). Psychiatric illness and virologic response in patients initiating highly active antiretroviral therapy. Journal of Acquired Immune Deficiency Syndromes, 44(2), 159–166. https://doi.org/10.1097/QAI.0b013e31802c2f51.

    Article  PubMed  Google Scholar 

  26. Poles, M. A., & Dieterich, D. T. (2000). Hepatitis C virus/human immunodeficiency virus coinfection: clinical management issues. Clinical Infectious Diseases, 31(1), 154–161. https://doi.org/10.1086/313892.

    CAS  Article  PubMed  Google Scholar 

  27. Quan, H., Li, B., Couris, C. M., Fushimi, K., Graham, P., Hider, P., et al. (2011). Updating and validating the Charlson comorbidity index and score for risk adjustment in hospital discharge abstracts using data from 6 countries. American Journal of Epidemiology, 173(6), 676–682. https://doi.org/10.1093/aje/kwq433.

    Article  PubMed  Google Scholar 

  28. Singer, M., Bulled, N., Ostrach, B., & Mendenhall, E. (2017). Syndemics and the biosocial conception of health. Lancet, 389(10072), 941–950. https://doi.org/10.1016/S0140-6736(17)30003-X.

    Article  PubMed  Google Scholar 

  29. Taylor, L. E., Swan, T., & Mayer, K. H. (2012). HIV coinfection with hepatitis C virus: evolving epidemiology and treatment paradigms. Clinical Infectious Diseases, 55(Suppl 1), S33–S42. https://doi.org/10.1093/cid/cis367.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  30. Vlahov, D., Robertson, A. M., & Strathdee, S. A. (2010). Prevention of HIV infection among injection drug users in resource-limited settings. Clinical Infectious Diseases, 50(Suppl 3), S114–S121. https://doi.org/10.1086/651482.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

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

Authors

Corresponding author

Correspondence to Viviane D. Lima.

Ethics declarations

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).

Disclaimer

All inferences, opinions, and conclusions drawn in this manuscript are those of the authors and do not reflect the opinions or policies of the data stewards.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

ESM 1

(DOCX 75 kb)

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

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

Download citation

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