Characterization Of Demographic, Behavioral, Immunologic, And Virologic Factors Associated With Incident And Prevalent Hepatitis C Virus Infection Among Hiv-Infected Men: Analysis Of 1948 Hiv-Infected Men In Baltimore, Maryland

Abstract

Recent reports around the world show that hepatitis C virus (HCV) infection rates among human immunodeficiency virus (HIV)-infected men who have sex with men (MSM) have increased in the past decade. The main goal of this thesis research was to characterize HCV infection among HIV-infected men with an aim of identifying new risk factors associated with HCV acquisition. This study assessed the cumulative prevalence of HCV and determined risk factors associated with prevalent and incident HCV infection. We employed a cross-sectional study evaluating 1948 HIV-infected men who had at least one HCV antibody test at Chase Brexton Health Care (CBHC) between 2011 and 2013. Multinomial logistic regression was used to establish crude and adjusted odds ratios at 95% confidence intervals (CI). The overall HCV prevalence for this sample of HIV-infected men was 24% (95% CI; 22–26), 85% among those who reported injection drug use (IDU), and 9% among those who did not report a history of IDU. Bivariate analyses suggested that lower education was less likely to be associated with HCV incidence, and those with prevalent HCV infection were more likely to be unemployed. In multivariate analysis, IDU was the only significant risk factor associated with incident HCV infection. Being ≥ 40 years old, having a history of IDU, and previous exposure to hepatitis B virus were positively associated with prevalent HCV infection, whereas, being MSM was negatively associated with HCV prevalence. Traditional risk factors typically associated with prevalent HCV infection, excluding IDU, were not associated with HCV incidence. Our study suggests that there may be a change in HCV risk factors between prevalent and incident HCV infection. The permucosal route seems to be the new mode of transmission driving HCV infection among this sample of HIV-infected MSM. We also found that a significantly larger proportion of those with incident HCV spontaneously cleared HCV compared to those with prevalent HCV infection. To add, we observed a high rate of sustained virologic response (SVR) among those with incident HCV, which may correspond to the high treatment completion rate. Our findings point to a changing epidemiology of HCV infection among HIV-infected men in Baltimore and highlight the emerging issue of sexual transmission of HCV among HIV-infected MSM in this area.