McKee Geoffrey, Butt Zahid A, Wong Stanley, Salway Travis, Gilbert Mark, Wong Jason, Alvarez Maria, Chapinal Nuria, Darvishian Maryam, Tyndall Mark W, Krajden Mel, Janjua Naveed Z
School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada.
British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada.
EClinicalMedicine. 2018 Nov 5;4-5:99-108. doi: 10.1016/j.eclinm.2018.10.006. eCollection 2018 Oct-Nov.
Limited data are available on HBV, HCV, and HIV co-infections and triple infection. We characterized co-occurrence of HIV, HBV, and HCV infections at the population level in British Columbia (BC) to identify patterns of predisposing factors unique to co-infection subgroups.
We analyzed data from the BC Hepatitis Testers Cohort, which includes all individuals tested for HCV or HIV in BC between 1992 and 2013, or included in provincial public health registries of HIV, HCV, HBV, and active tuberculosis. Individuals were classified as negative, mono-, and co-infection groups based on HIV, HBV, and HCV status. We evaluated associations between risk factors (injection drug use, sexual orientation etc.) and co-infection groups using multivariate multinomial logistic regression.
Of a total of 1,376,989 individuals included in the analysis, 1,276,290 were negative and 100,699 were positive for HIV, HBV, and/or HCV. Most cases (91,399, 90.8%) were mono-infected, while 3991 (4.0%) had HBV/HCV, 670 HBV/HIV (0.7%), 3459 HCV/HIV (3.4%), and 1180 HBV/HCV/HIV (1.2%) co-infection. Risk factor and demographic distribution varied across co-infection categories. MSM classification was associated with higher odds of all HIV co-infection groups, particularly HBV/HIV (OR 6.8; 95% CI: 5.6, 8.27), while injection drug use was most strongly associated with triple infection (OR 64.19; 95% CI: 55.11, 74.77) and HIV/HCV (OR 23.23; 95% CI: 21.32, 25.31).
Syndemics of substance use, sexual practices, mental illness, socioeconomic marginalization, and co-infections differ among population groups, highlighting avenues for optimal composition and context for health services to meet each population's unique needs.
BC Centre for Disease Control and Canadian Institutes of Health Research.
关于乙肝病毒（HBV）、丙肝病毒（HCV）和人类免疫缺陷病毒（HIV）合并感染及三重感染的数据有限。我们对不列颠哥伦比亚省（BC）人群中HIV、HBV和HCV感染的共现情况进行了特征分析，以确定合并感染亚组特有的易感因素模式。
我们分析了BC肝炎检测队列的数据，该队列包括1992年至2013年间在BC接受HCV或HIV检测的所有个体，或纳入省级HIV、HCV、HBV和活动性结核病公共卫生登记的个体。根据HIV、HBV和HCV状态，个体被分为阴性、单一感染和合并感染组。我们使用多变量多项逻辑回归评估风险因素（注射吸毒、性取向等）与合并感染组之间的关联。
在分析纳入的总共1376989名个体中，1276290名个体HIV、HBV和/或HCV检测为阴性，100699名个体检测为阳性。大多数病例（91399例，90.8%）为单一感染，而3991例（4.0%）为HBV/HCV合并感染，670例（0.7%）为HBV/HIV合并感染，3459例（3.4%）为HCV/HIV合并感染，1180例（1.2%）为HBV/HCV/HIV三重感染。风险因素和人口统计学分布在不同的合并感染类别中有所不同。男男性行为者分类与所有HIV合并感染组的较高几率相关，尤其是HBV/HIV合并感染（比值比6.8；95%置信区间：5.6，8.27），而注射吸毒与三重感染（比值比64.19；95%置信区间：55. 11，74. 77）和HIV/HCV合并感染（比值比23.23；95%置信区间：21. 32，25. 31）的关联最为强烈。
物质使用、性行为、精神疾病、社会经济边缘化和合并感染的综合征在不同人群组中存在差异，这凸显了卫生服务的最佳构成和背景，以满足每个人群的独特需求。
BC疾病控制中心和加拿大卫生研究院。
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