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REAL-TIME TRACKING OF HCV AND HIV CO-INFECTIONS IN BC: IMPLICATIONS FOR PREVENTION AND CARE
A Yu, J Buxton, P Kim, M Alvarez, D Taylor, ML Rekart, M Krajden
British Columbia Centre for Disease Control (BCCDC), Vancouver
PURPOSE: The objective of this study was to link HIV and HCV surveillance and laboratory databases to examine HIV and HCV co-infection in a population-based sample from British Columbia (BC), Canada.
METHODS: Data linkage required IRB ethics approval, a Privacy Impact Assessment and a Memorandum of Understanding between the BC Ministry of Health and the BCCDC which took 3 yrs. Multiple logistic regression was used to assess the association between the binary outcome variable and explanatory variables.
RESULTS: Of 3832 linkable reactive HIV tests, 2507 (65%) had tested for HCV. Of these 2507, 1431 (57%) had reactive tests for both anti-HIV and anti-HCV. Of these 1431 cases, 711 (50%) tested anti-HCV reactive first, 319 (22%) tested anti-HIV reactive first and 401 (28%) had both reactive within a 2 wk window. The median time from first reactive anti-HCV to the first reactive anti-HIV was 1111 days (inter-quartile range 405-2096) and the median time from first reactive anti-HIV to first positive anti-HCV was 403 days (inter-quartile range 76-1263). Compared to non-co-infected patients, co-infection was significantly associated with female gender (OR 1.46, 95%CI 1.19, 1.79), Aboriginal ethnicity (OR 3.00, 95%CI 2.33, 3.86) and residence on Vancouver Island (OR 2.67, 95%CI 2.04, 3.49).
CONCLUSION: The HIV/HCV co-infection rate in this population-based, laboratory tested sample was 57%. When anti-HCV was detected first, the time to anti-HIV detection was approx. 3 yrs; when anti-HIV was detected first, the time to anti-HCV detection was approx. 1 yr.; 28% had their first reactive test for both viruses within a 2 week period. Data linkage enables population based estimates of HIV and HCV co-infection in BC. Co-infection is correlated with female gender, Aboriginal ethnicity and living on Vancouver Island. This real-time data linkage highlights the potential value of identifying incident HCV infection as a tool to target individuals who are at risk of subsequent HIV infection as well as tracking incident co-infections to monitor disease burden.