Concurrent Hepatitis C and B Virus and Human Immunodeficiency Virus Infections Are Associated With Higher Mortality

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Zahid A Butt1,2,3, Stanley Wong2, Carmine Rossi2

  • 1School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada.

Open Forum Infectious Diseases
|September 23, 2020
PubMed

Insights

Concurrent infections with Hepatitis C virus (HCV), Hepatitis B virus (HBV), and Human Immunodeficiency Virus (HIV) significantly increase mortality risk. Addressing substance use and comorbidities alongside viral treatments can reduce deaths.

Area of Science:

  • Virology
  • Epidemiology
  • Public Health

Background:

  • Hepatitis C virus (HCV), hepatitis B virus (HBV), and human immunodeficiency virus (HIV) are major global health concerns.
  • Limited data exist on the mortality risks associated with concurrent infections of these viruses.
  • This study investigates the impact of single and multiple viral infections on mortality in British Columbia.

Purpose of the Study:

  • To evaluate the effect of HCV, HBV, and HIV infections and coinfections on all-cause mortality.
  • To identify factors associated with increased mortality risk in individuals with these viral infections.
  • To inform public health strategies for reducing mortality related to viral coinfections.

Main Methods:

  • Utilized the BC Hepatitis Testers Cohort, including ~1.7 million individuals tested or reported for HCV, HBV, or HIV from 1990-2015.
  • Followed individuals with monoinfection, coinfections, or triple infections from their negative status to death or end of 2016.
  • Employed extended Cox proportional hazards regression to determine mortality risk factors and hazard ratios (HRs).

Main Results:

  • Out of 658,704 individuals, 33,804 (5.13%) deaths were recorded.
  • HCV/HBV/HIV triple infection showed the highest mortality risk (HR, 8.9), followed by HCV/HIV (HR, 4.8), HBV/HIV (HR, 4.1), and HCV/HBV (HR, 3.9).
  • Monoinfections also increased mortality risk (HCV: HR 2.6, HBV: HR 2.2, HIV: HR 1.6), with injection drug use, alcohol use, material deprivation, and comorbidities being significant factors.

Conclusions:

  • Concurrent multiple viral infections are strongly linked to elevated mortality.
  • Substance use, comorbidities, and socioeconomic factors independently contribute to mortality risk.
  • Integrated preventive strategies, including harm reduction and coinfection treatment, are crucial for reducing mortality.
Abstract

Keywords:
all-cause mortalitycoinfectionsobservational cohortsyndemics

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