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Effect of opioid-substitution therapy and mental health counseling on HIV risk among hepatitis C-infected individuals

Background

Hepatitis C virus (HCV) and HIV infection commonly co-occur because of shared transmission routes and risk behaviors. HIV infection among individuals living with HCV is a major predictor of morbidity and mortality.

Risk factors for HCV co-infection among people living with HIV include injection drug use (IDU), alcohol use, unsafe sex among gay, bisexual and other men who have sex with men (MSM) and social disparities.

Preventive factors for HIV infection, particularly among people who inject drugs (PWID) (who are also more likely to have HCV infection), may include opioid substitution therapy (OST), mental health counselling and other harm reduction strategies. However, data on risk factors for HIV among people living with HCV is limited and the role of preventive factors has not been investigated.

Purpose of research

Data on preventive factors for HIV infection from a real-world setting could inform programs to reduce the burden of HIV among people living with HCV.

The purpose of this study was to evaluate the risk of HIV and factors preventing and promoting this risk among people living with HCV in British Columbia. This study analyzed data from the British Columbia Hepatitis Testers Cohort on HCV and HIV collected between the years 1990 and 2013.

Key findings

In this study, out of 36,077 HCV positive individuals, 2169 (6.0%) developed HIV infection. The risk of HIV infection was higher among those with acute HCV infection (seroconverters) than those with chronic HCV infection. Being male, having a history of IDU, mental illness, hepatitis B virus (HBV), MSM status, younger age and urban residence were associated with a higher risk of HIV.

Among those with HCV infection (after adjusting for confounders), MSM, PWID, people living in urban areas, and those who were also infected with HBV were at a higher risk of HIV infection. OST and using mental health counseling services significantly reduced the risk of getting HIV infection among HCV positive individuals.

Implications

This study provides further support for the role of OST and mental health services in reducing infections that are transmitted through blood and other bodily fluids. Improving access to OST and mental health services could prevent transmission of HIV and other blood borne infections in Canada and globally.

For more information

The study was recently published in Clinical Epidemiology.

Butt ZA, Shrestha N, Gesink D, Murti M, Buxton JA, Gilbert M, Balshaw RF, Wong S, Kuo M, Wong J, Yu A, Alvarez M, Samji H, Roth D, Consolacion T, Hull MW, Ogilvie G, Tyndall MW, Krajden M, Janjua NZ. Effect of opioid-substitution therapy and mental health counseling on HIV risk among hepatitis C-infected individuals. Clin Epidemiol. 2018 Aug 31;10:1127-1145. doi: 10.2147/CLEP.S173449. https://www.dovepress.com/effect-of-opioid-substitution-therapy-and-mental-health-counseling-on--peer-reviewed-article-CLEP#

Acknowledgements

This study was supported by the Canadian Institutes of Health Research and the BC Centre for Disease Control.

Categories: New knowledge

Search related content: hepatitis C, HCV, HIV, mental health, opioid-substitution therapy

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