Académique Documents
Professionnel Documents
Culture Documents
Suggested citation
Kuehlkamp VM, Schneider IJC, Biudes MF, Galato D, da Silva J, Maurici R, et al. Factors associated
with hepatitis C seropositivity in people living with HIV. Rev Panam Salud Publica. 2014;35(1):539.
abstract
Objective. To identify risk factors associated with hepatitis C virus (HCV) seropositivity
in human immunodeficiency virus (HIV)-infected patients.
Methods. A paired case-control study adjusted by age and gender was conducted. It
included adults coinfected with HIV and HCV (cases) and HIV mono-infected subjects
(controls) using non-probability sampling. Data were collected through interviews and review
of medical records. The chi-square test was used for comparing categorical variables and the
Students t-test or Wilcoxon (MannWhitney U) test for continuous variables. Confidence
intervals (95%) were estimated along with crude and adjusted odds ratios using conditional
logistic regression.
Results. A total of 165 patients were surveyed, including 55 cases and 110 controls. The
mean age was 43.6 8.4 years, ranging from 19 to 64 years; 70.9% were male. Independent
risk factors for HIV/HCV coinfection were education (up to eight years of schooling); age
at first intercourse < 15 years; having undergone tattooing; blood transfusion; and use of
injecting drugs.
Conclusions. Low level of education, early age at first sexual intercourse, tattooing, blood
transfusions, and sharing needles and other drug injection equipment were factors that
increased the risk of HIV/HCV coinfection. The results from this research can be compared with
similar data from other regions to help direct preventive and educational efforts targeting people
living with HIV.
Key words
53
Original research
Kuehlkamp et al. Factors associated with hepatitis C seropositivity in people living with HIV
54
FIGURE 1. Hierarchical model for selection of confounding variables associated with HIV/
hepatitis C virus coinfection among HIV-infected patients at outpatient clinics in three cities in
Santa Catarina State, Brazil, October 2011August 2012
1st LEVEL
Demographic characteristics
Gender
Age
Skin color
Socioeconomic characteristics
Education
Household income
2nd LEVEL
Sexual behavior
Lifestyle behavior
Tattooing
Sharing personal hygiene objects
Alcohol consumption
OUTCOME
HIV/HCV coinfection
Kuehlkamp et al. Factors associated with hepatitis C seropositivity in people living with HIV
The first block of the model included variables with P < 0.05. The
second block included variables with
P < 0.20. Variables with P < 0.05 in
this block were considered significant, and the variables of the previous block were maintained, even with
P > 0.05. This procedure was repeated
for the third, fourth, and fifth blocks.
This study was approved by the Research Ethics Committee of the University of Southern Santa Catarina (Santa
Catarina State, Brazil) under registration
number 11.060.4.01.III.
RESULTS
In total, 165 HIV-infected individuals were studied, of whom 55 were
considered cases (HIV/HCV-coinfected)
and 110 controls (HIVmono-infected),
paired by age and gender.
The mean age of the surveyed subjects
was 43.6 (standard deviation (SD) = 8.4)
years, ranging from 19 to 64 years; 70.9%
were male. The majority (79%) of respondents lived with relatives, 18% lived
alone, and the remainder lived with
friends or in institutions.
Household income and the number
of lifetime sexual partners showed an
asymmetric distribution. With regard to
the comparison between medians, it was
found that cases had lower household
income (P = 0.011) and a higher number of sexual partners (P = 0.047) than
controls.
Table 1 shows the distribution of
variables between the groups and the
results of univariate and multivariate
analysis.
Original research
Variable
Socio-demographic
Skin color
White
Non-white
Education (in years)
08
9
Household income (R$c)
0.00130000
> 130000
Sexual behavior
First intercourse (age in
years)
15
> 15
Sexual orientation
Homosexual/bisexual
Heterosexual
Number of lifetime sexual
partners
015
> 15
Unprotected sex
Yes
No
Lifestyle behavior
Tattooing
Yes
No
Sharing personal objects
Yes
No
Morbidity
Blood transfusion
Yes
No
Drug use
Injecting-drug
Yes
No
Cocaine
Yes
No
Crack
Yes
No
Alcohol
Yes
No
Cases
(%)
(n = 55)
Controls
(%)
(n = 110)
Crude OR
(95% CIb)
74.5
25.5
86.4
13.6
1
2.03 (0.934.46)
76.4
23.6
56.0
44.0
2.67 (1.205.92)
1
62.7
37.3
46.3
53.7
1.96 (0.983.93)
1
Adjusted OR
(95% CI)
0.060
1
2.28 (0.955.46)
0.011
2.95 (1.217.19)
1
0.053
1.40 (0.653.03)
1
0.005
64.8
35.2
41.7
58.3
2.48 (1.235.03)
1
12.7
87.3
26.4
73.6
1.81 (0.883.75)
1
2.21 (1.024.79)d
1
0.045
2.76 (0.948.09)d
1
0.122
46.3
53.7
59.1
40.9
1
1.79 (0.823.89)
69.1
30.9
56.4
43.6
1.81 (0.883.75)
1
63.6
36.4
19.1
80.9
2.24 (1.074.68)
1
47.3
52.7
43.6
56.4
1.11 (0.602.07)
1
61.8
38.2
88.3
11.8
5.30 (2.0913.41)
1
56.4
43.6
3.6
96.4
41.6 (5.59308.67)
1
67.3
32.7
25.5
74.5
7.13 (2.9317.33)
1
41.8
58.2
13.6
86.4
5.60 (2.2414.03)
1
70.9
29.1
68.2
31.8
1.1 (0.62.3)
1
1.68 (0.664.24)d
0.115
0.016
2.47 (0.996.16)d
1
2.25 (1.014.97)e
1
0.658
< 0.001
< 0.001
< 0.001
< 0.001
6.17 (2.0218.79)f
1
21.32 (2.00226.68)g
1
2.25 (0.647.85)g
1
1.57 (0.337.34)g
1
0.721
a Conditional
55
Original research
Kuehlkamp et al. Factors associated with hepatitis C seropositivity in people living with HIV
DISCUSSION
56
Kuehlkamp et al. Factors associated with hepatitis C seropositivity in people living with HIV
Limitations
Limitations of this study were 1) the
exclusion of some individuals with incomplete medical records; 2) the lack of
data on anti-HCV results in the medical
records; and 3) the exclusion of patients with negative serology for antiHCV who had old serological records
(to avoid including patients who had
become coinfected since their last test).
In addition, the inclusion of patients
with positive serology for anti-HCV
may have resulted in an overestimation
of the coinfection percentage caused by
possible false-positive results, as the
anti-HCV test does not define active
HCV infection, a status that requires
molecular biology tests such as HCVRNA for confirmatory diagnosis. As
those results were not always available in patient medical records, health
Original research
Conclusion
The results from this study showed
that the independent factors associated
with HIV/HCV coinfection were poor
education, early first sexual intercourse,
tattooing, previous blood transfusion,
and intravenous drug use.
Based on the findings from this study,
the authors suggest that health information about the risk factors for HCV
infection be provided on an ongoing
basis, especially among HIV-infected
patients, to prevent coinfection. Preventive education against drug abuse along
with effective measures to improve
health and quality of life are of utmost
importance.
Acknowledgments. The authors
thank the teams of the Centro de Atendimento Especializado em Sade (CAES),
Vigilncia Epidemiolgica de Tubaro, Policlnica Municipal de Imbituba, and Unidade
Sanitria Central de Capivari de Baixo for
allowing this study to be performed.
They also thank the Support Program for
Post Graduate Private Teaching Institutions (Programa de Suporte Ps-Graduao de Instituies de Ensino Particulares,
PROSUP) of the Coordination for the
Improvement of Higher Education Personnel (Coordenao de Aperfeioamento
de Pessoal de Nvel Superior, CAPES) Program of the Brazilian Ministry of Education for financial support.
Conflicts of interest. None.
57
Original research
Kuehlkamp et al. Factors associated with hepatitis C seropositivity in people living with HIV
REFERENCES
1. Sherman KE, Rouster SD, Chung RT, Rajicic
N. Hepatitis C Virus prevalence among patients infected with Human Immunodeficiency Virus: a cross-sectional analysis of the
US adult AIDS Clinical Trials Group. Clin
Infect Dis. 2002;34(6):8317.
2. Pereira GA, Stefani MM, Martelli CM, Turchi
MD, Siqueira EM, Carneiro MA, et al. Human
immunodeficiency virus type 1 and hepatitis
C virus co-infection and viral subtypes at
an HIV testing center in Brazil. J Med Virol.
2006;78(6):71923.
3. Bruno R, Sacchi P, Puoti M, Soriano V, Filice G. HCV chronic hepatitis in patients
with HIV: clinical management issues. Am J
Gastroenterol. 2002;97(7):1598606.
4. Balogun TM, Emmanuel S, Wright KO. Hepatitis C virus co infection in HIV positive patients. Nig Q J Hosp Med. 2010;20(3):11720.
5. Ministrio da Sade, Secretaria de Vigilncia em Sade, Departamento de Aids, DST
e Hepatites Virais (BR). Boletim epidemiolgico: hepatites virais2011. Braslia: MS;
2012. Available from: http://www.aids.
gov.br/sites/default/files/anexos/publi
cacao/2011/50073/boletim_hepatites2011_
pdf_64874.pdf Accessed on 10 March 2013.
6. Kuehlkamp VM, Schuelter-Trevisol F. Prevalence of human immunodeficiency virus/
hepatitis C virus coinfection in Brazil and
associated factors: a review. Braz J Infect Dis.
2013;17(4):45563.
7. Ministrio da Sade, Secretaria de Vigilncia
em Sade, Departamento de Aids, DST e Hepatites Virais (BR). Boletim epidemiolgico:
Aids e DST2011. Braslia: MS; 2012. Available from: http://www.aids.gov.br/sites/de
fault/files/anexos/publicacao/2011/50652/
boletim_aids_2011_final_m_pdf_26659.pdf
Accessed on 15 July 2013.
8. Ragni MV, Belle SH. Impact of human immunodeficiency virus infection on progression
to end-stage liver disease in individuals with
hemophilia and hepatitis C virus infection. J
Infect Dis. 2001;183(7):11125.
9. Benhamou Y, Bochet M, Di Martino V,
Charlotte F, Azria F, Coutellier A, et al. Liver
fibrosis progression in human immunodeficiency virus and hepatitis C virus coinfected
patients. The Multivirc Group. Hepatology.
1999;30(4):10548.
10. Lesens O, Deschnes M, Steben M, Blanger
G, Tsoukas CM. Hepatitis C virus is related
to progressive liver disease in human immunodeficiency virus-positive hemophiliacs and
should be treated as an opportunistic infection. J Infect Dis. 1999;179(5):12548.
11. Wolff FH, Fuchs SC, Barcellos NT, Falavigna
M, Cohen M, Brandro AB, et al. Risk factors for hepatitis C virus infection in individuals infected with the HIV. Dig Liver Dis.
2008;40(6):4607.
12. Brito VO, Parra D, Facchini R, Buchalla CM.
Infeco pelo HIV, hepatites B e C e sfilis
em moradores de rua, So Paulo. Rev Saude
Publica. 2007;41 Suppl 2:4756.
13. Mendes-Corra MC, Barone AA, Guastini C.
Hepatitis C virus seroprevalence and risk fac-
58
Manuscript received on 8 July 2013. Revised version accepted for publication on 12 January 2014.
Kuehlkamp et al. Factors associated with hepatitis C seropositivity in people living with HIV
resumen
Palabras clave
Original research
59