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BACKGROUND: Reciprocal interaction between hepatitis C virus (HCV) and HIV infections may modulate the natural history of both diseases thereby impacting morbidity and mortality. Although Utah conducts surveillance for both HCV and HIV, this surveillance occurs in separate systems and programs and the association between co-infection and morbidity and mortality in Utah is not well known. The objective of this analysis was to electronically link death record and surveillance data to assess trends in HCV co-infection among people living with HIV/AIDS (PLWHA) in Utah.
METHODS: Electronic record linkage was utilized to match HCV cases reported between 2009 and 2013 in TriSano, Utah’s disease surveillance system, with vital statistics death certificate records and the Utah Enhanced HIV Analysis and Reporting System (eHARS) data. The variables used for record linkage were first and last name, gender, and birthdate. Deaths among this population were identified. Prevalence of co-infection was estimated for this time period. Odds ratios and 95% confidence intervals were calculated in bivariate analyses to estimate the association between HCV infection and mortality and potential risk factors. Multivariate logistic regression was utilized to examine the association between HCV infection and death when controlling for these factors.
RESULTS: The results of this analysis suggest that the prevalence of HCV co-infection has increased from 2.4% of 2383 PLWHA at the beginning of 2009 to 3.9% of the 2872 PLWHA at the end of 2013. There were significant associations between HCV infection and death during this time period (OR=3.81, 95% CI 2.17-6.71, p<0.0001), injection drug use (IDU) (OR=4.63, 95% CI 3.24-6.60 p<0.0001), being a man who has sex with men (MSM) (OR=0.54, 95% CI 0.38-0.77, p=0.0006), and older age (OR=1.02, 95% CI=1.00-1.03, p=0.0193) in the bivariate analyses. Within the multivariate model for HCV, death, gender, and IDU and MSM status were significantly associated with HCV infection. When controlling for potential confounding factors, PLWHA co-infected with HCV continued to be at greater odds of death (OR 3.23, 95% CI 1.80-5.77, p<0.0001).
CONCLUSIONS: These data suggest that electronic record linkage is useful to assess morbidity and mortality associated with HCV infection among PLWHA. The prevalence of HCV co-infection among Utah PLWHA has increased and when controlling for potential risk factors, the odds of death were significantly elevated for PLWHA who were co-infected when compared to those who were not. This information may be useful for programs to advocate for and focus HCV treatment for those who would benefit most.