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Dissertation
Epidemiology of HIV-1 and hepatitis virus co-infection: distribution and pathogenesis in an urban clinic population
Doctor of Philosophy (Ph.D.), Drexel University
Dec 2012
DOI:
https://doi.org/10.17918/etd-6729
Abstract
Given similar routes of exposure, hepatitis B virus (HBV) and hepatitis C virus (HCV) co-infection is common among HIV-positive populations. The long-term impact of these is becoming an important public health concern, given the high rates of co-exposure coupled with increased AIDS-related survival and widespread accessibility of antiretroviral therapy. Using a population drawn from an urban HIV clinic, we investigated prevalence rates of co-exposure, and identified factors associated with co-exposure, sexual transmission of HCV, and HCV viral clearance using a cross-sectional study design on data collected from 2002-11. We also conducted survival analyses using Cox proportional hazards regressions to model the risk of progression to four outcomes (clinical AIDS, all-cause mortality, HIV virologic failure, and decline in CD4 count) based on HBV and HCV status. Among 2,880 HIV-positive subjects, relatively high seroprevalences of HBV (44%), HCV (34%), and HBV/HCV (19%) was observed. Injection drug users (IDUs) had the greatest odds of each co-exposure. Additionally, race, sex, socioeconomic status, older age, and more recent HIV diagnosis were associated with co-exposure. Sexual transmission of HCV was associated with Black race, younger age, and a more recent HIV diagnosis Among subjects with a history of HCV exposure, 13% had evidence of HCV viral clearance; being HBV surface antigen-positive was highly predictive of clearance. In the survival analysis, HBV status negatively affected HIV disease progression, particularly time to clinical AIDS and HIV virologic failure. Additionally, HCV status may be related to faster progression to clinical AIDS and all-cause mortality. Taken together, our findings highlight the burden of viral hepatitis co-infections among HIV-positive individuals, and the need to reduce this burden through routine testing, HBV vaccination, and appropriate therapy. Further research, particularly with a prospective study design, is warranted to fully understand the factors associated with viral hepatitis co-infection among HIV-positive populations. Identification of those more likely to develop chronic HCV infections can inform therapy decisions. Further, given the relatively high rates of HBV and HCV co-infection and the current debate on their impact on HIV disease progression, additional research is needed to further elucidate these relationships.
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Details
- Title
- Epidemiology of HIV-1 and hepatitis virus co-infection
- Creators
- Kristen Melissa Johnson - DU
- Contributors
- Seth Welles (Advisor) - Drexel University (1970-)
- Awarding Institution
- Drexel University
- Degree Awarded
- Doctor of Philosophy (Ph.D.)
- Publisher
- Drexel University; Philadelphia, Pennsylvania
- Resource Type
- Dissertation
- Language
- English
- Academic Unit
- Epidemiology and Biostatistics [Historical]; School of Public Health (2002-2015); Drexel University
- Other Identifier
- 6729; 991014632067804721