Factors associated with HCV risk practices in HIV-HCV co

Abstrac t
Background: Despite access to opioid substitution treatment, HCV prevalence in drug users remains high and HCV risk practices are a major concern in HIV-HCV infected drug users. In addition, drug and alcohol use in these patients
represents major barriers to HCV treatment. The aim of this study was to determine factors associated with HCV risk-behaviours among HIV-HCV co-infected patients.
Methods: Analysis was conducted on data of 535 HIV-HCV co-infected patients (722 visits) recruited in the French nationwide HEPAVIH cohort. Data collection based on medical records and self-administered questionnaires was
scheduled every 12 months and included among other information, data about drug and alcohol use.
A 3-level outcome variable was used: no drug use, drug snorting without injection and drug injection in the 6 months prior to the visit. A multinomial logistic regression for clustered data was used to identify factors associated with
drug snorting and drug injection.
Results: Among the 535 individuals, median [IQR] age 45[42-47], 384 (72%) were men, 253 were employed (48%). Drug snorting and drug injection during follow-up were reported respectively by 48 patients (56 visits (8%)) and by
35 patients (41 visits (6%)). Binge drinking was reported by 291 patients (34%) and 109 patients (21%) reported daily cannabis use. Depressive symptoms were found in 245 individuals (48%).
After multiple adjustment for age, unemployment and being renter or owner of their house, factors associated with drug snorting were daily cannabis use (OR[95%CI]=3.1[1.6-6.0]) and depressive symptoms
(OR[95%CI]=2.6[1.3-5.3]) and only binge drinking (OR[95%CI]=2.3[1.0-5.0]) was significantly associated with drug injection.
Conclusions: Access to and diversification of different approaches to manage co-dependence and depressive symptoms need to be combined with interventions to reduce harmful alcohol consumption. Such integration of
approaches is also the necessary step to minimise harms from drug and alcohol use and therefore from delayed access to HCV treatment.
Keywords: HIV, HCV, drug use, alcohol consumption, depression.
Factors associated with HCV risk practices in HIV-HCV co-infected patients:
results from the French ANRS CO13 HEPAVIH cohort.
AUTHORS
Julien Cohen1,2,3, Perrine Roux1,2,3, Dominique Salmon4, Maria Winnock5,
François Dabis5, Bruno Spire1,2,3, M.Patrizia Carrieri1,2, 3
Outcome variable
Number of visits (%)
Number of patients
625 (87)
56 (8)
41 (6)
477
48
35
Drug use
- No drug use
- Drug snorting
- Drug injection
1 INSERM, U912 (SE4S), Marseille, France
2 Université Aix Marseille, IRD, UMR-S912, Marseille, France
3 ORS PACA, Observatoire Régional de la Santé Provence Alpes Côte d'Azur, Marseille, France
4 Hôpital Cochin-Port-Royal, Paris, France
5 INSERM, U897, Bordeaux, France
Background
Despite the French harm reduction policy which
contributed to significantly decrease HIV among drug
users, HCV prevalence is still very high due to the
persistence of specific risk behaviours, such as drug
snorting and injection.
Drug use in HIV-HCV co-infected patients is a major barrier
to access to HCV treatment.
The aim of this study is to determine factors associated with
HCV risk behaviours among HIV-HCV co-infected patients.
HEPAVIH French Cohort Study (ANRS CO13) : design
Started in october 2005 with the participation of 17
different hospital out-patient facilities providing care
for people living with HIV and HCV in France
Patients with dual HIV-1 and HCV infections, confirmed
by HIV and HCV RNA were enrolled in the cohort,
regardless of their clinical stage, gender or HIV and HCV
transmission group.
Data collection
Clinical and biological data including plasma HIV RNA,
CD4 cell count, and liver fibrosis were obtained from
medical records
The self-administered questionnaire included items on
socio-demographic characteristics, treatment history
and ongoing treatments, alcohol and tobacco
consumption and drug use
Univariate analysis
Drug snorting
Drug injection
p-value OR (95% CI)
p-value OR (95% CI)
Male gender
0.82 0.92 (0.46-1.87)
0.03 2.90 (1.10-7.63)
Agea
0.001 0.32 (0.16-0.64)
0.13 0.50 (0.20-1.24)
Unemployment
0.45 1.25 (0.70-2.25)
0.03 2.11 (1.09-4.09)
High school certificate
0.49 0.77 (0.36-1.62)
0.10 0.44 (0.16-1.17)
Children
0.17 0.57 (0.26-1.26)
0.95 0.97 (0.42-2.23)
Good housing conditions
0.08 0.56 (0.29-1.07)
0.09 0.51 (0.23-1.11)
Owner or renter of their house 0.02 0.42 (0.20-0.87) 0.005 0.30 (0.13-0.69)
Daily cannabis use
0.001 2.85 (1.54-5.29)
0.36 1.49 (0.63-3.53)
Binge drinking
0.25 1.44 (0.78-2.69)
0.05 2.11 (1.01-4.42)
More than 20 cigarettes a day 0.95 1.03 (0.46-2.27) 0.008 2.90 (1.33-6.35)
Depressive symptoms
0.004 2.58 (1.36-4.88)
0.62 1.20 (0.58-2.45)
Antidepressant consumption 0.02 2.12 (1.15-3.89)
0.21 1.58 (0.78-3.20)
Number of years since
first positive HIV testa
0.21 0.71 (0.42-1.20)
0.66 0.80 (0.30-2.13)
CD4 cell count >= 200
0.70 0.79 (0.23-2.69)
0.03 0.34 (0.14-0.88)
a For ten years increase
Multivariate analysis
Drug snorting
p-value AOR (95% CI)
Male gender
0.51 1.35 (0.55-3.30)
Agea
0.002 0.28 (0.15-0.55)
Unemployment
0.60 1.21 (0.60-2.43)
Owner or renter of their home 0.02 0.39 (0.17-0.82)
Daily cannabis use
0.001 3.18 (1.83-5.54)
Depressive symptoms
0.01 2.56 (1.23-5.32)
Binge drinking
0.37 1.40 (0.67-2.95)
Drug injection
p-value AOR (95% CI)
0.05 2.64 (0.98-7.15)
0.08 0.45 (0.19-1.10)
0.05 2.11 (1.00-4.47)
0.02 0.34 (0.17-0.71)
0.52 1.36 (0.54-3.46)
0.81 0.90 (0.40-2.02)
0.05 2.15 (0.97-4.76)
a For ten years increase
Summary of the results
After multiple adjustment for gender, age, unemployment
and being renter or owner of their house:
The self-administered questionnaire also collected
psychosocial data such as depressive symptoms (CES-D) - Depressive symptoms and daily cannabis use were
associated with drug snorting
and use of antidepressants.
Binge
drinking
was
associated
with
drug
injection.
Statistical methods
Analysis included 535 HIV-HCV co-infected patients
(722 visits) of the French HEPAVIH cohort.
A 3-level outcome variable was used: no drug use, drug
snorting without injection, and drug injection in the 6
months prior to the visit.
A multinomial logistic regression model for clustered
data was used to identify factors associated with drug
snorting and drug injection.
Baseline characteristics of patients (n=535)
n (%) or median [IQR]
No
Drug
Drug
drug use
snorting
injection
Socio-demographic data
Male gender
Age
Unemployment
High school certificate
Children
Good housing conditionsa
Owner or renter of their house
Substance use
Heroin use
Cocaine use
Daily cannabis use
Binge drinkingb
More than 20 cigarettes a day
Depression
Depressive symptomsc
Antidepressant consumption
HIV-related data
Number of years since
first positive HIV test
Receiving HAART
CD4 cell count
Undetectable viral load
HCV-related data
Number of years since
first positive HCV test
History of pegylated IFN/RBV
treatment
Severe fibrosis (>=F3)
316 (72)
45 [42-47]
226 (53)
97 (25)
146 (34)
373 (85)
409 (92)
27 (68)
42 [41-46]
21 (55)
9 (26)
9 (22)
31 (78)
32 (80)
25 (89)
43 [41-46]
20 (71)
4 (15)
9 (32)
20 (71)
20 (77)
0 (0)
0 (0)
71 (16)
149 (35)
140 (40)
11 (28)
29 (73)
14 (38)
17 (44)
12 (43)
8 (29)
13 (46)
6 (24)
15 (54)
15 (60)
174 (42)
97 (22)
27 (68)
16 (41)
12 (44)
9 (33)
18 [14-20]
16 [13-19]
397 (91)
36 (92)
459 [300-666] 433 [349-647]
316 (86)
25 (89)
19 [15-20]
26 (93)
394 [252-526]
19 (79)
11 [8-15]
11 [8-14]
12 [6-17]
106 (28)
139 (37)
10 (31)
10 (31)
9 (35)
10 (38)
a Defined as the rank 3 and 4 (quite or very comfortable vs. no or low comfort) using a four-point Likert scale.
b Defined as drinking more than as more than 5 alcohol units (AU) per occasion.
c Patients were defined with depressive symptoms if CES-D>17 for men and >23 for women.
Correspondance :
INSERM U912, 23 rue Stanislas Torrents, 13006 Marseille, France
mail : [email protected]
tél :+33 4 96 10 28 75
Fax : + 33 4 96 10 28 99
CONCL US IONS
Access to and diversification of different approaches to
manage co-dependence and depressive symptoms
need to be combined with interventions to reduce
harmful alcohol consumption.
Such integration of approaches is also necessary to
minimise harms from drug and alcohol use, to improve
the patient/physician relationship and therefore to
increase access to HCV treatment.
Acknowledgements
Principal investigators: D. Salmon-Ceron, F. Dabis
Methodology: F. Dabis, M. Winnock
Management Center: M. Winnock, MA. Loko, L. Dequae Merchadou, S. Gillet
Hepatology: Y. Benhamou, P. Sogni
Virology: J.Izopet, M-E.Lafon
Social Sciences: B. Spire, MP. Carrieri, P. Roux, L. Michel, J. Cohen, V. Villes, M.
Mora, P. Kurkdji
Financial Support: Agence Nationale de Recherche sur le SIDA et les
hépatites (ANRS)
List of participating groups: (ANRS CO13 HEPAVIH)
AC7 cohorts: AQUITAINE (F. Dabis), RIBAVIC (F. BaniSadr), SEROCO/HEMOCO
(L. Meyer)
Clinical Centers: Paris: Hôpital Cochin - Service de Médecine Interne 2,
Hôpital Tenon - Service des Maladies Infectieuses, Hôpital Pitié-Salpêtrière Service des Maladies Infectieuses, Hôpital Avicenne - Service de Médecine
Interne, Hôpital Bichat-Claude Bernard - Service des Maladies Infectieuses
A, Hôpital de Bicêtre - Service de Médecine Interne , Hôpital Necker-Enfants
Malades - Service des Maladies Infectieuses, Hôpital Saint Antoine - Service
des Maladies Infectieuses, Hôpital Saint Louis - Service de Médecine
Interne, Hôpital Paul Brousse - Service des Maladies Infectieuses ;Marseille:
Hôpital Sainte Marguerite - Service Hématologie et VIH ; Nice: Hôpital de
l'Archet - Services des Maladies Infectieuses et de Médecine Interne ;
Toulouse: Hôpital Purpan - Services des Maladies Infectieuses et de
Médecine Interne, Hôpital Joseph Ducuing - Service de Médecine Interne;
Bordeaux: Hôpital Pellegrin - Services des Maladies Infectieuses A et B,
Hôpital Saint André Service de Médecine Interne, Hôpital Haut Lévêque
Service de Médecine Interne A
Associated team: UMR912 INSERM-IRD-Université de la Méditerranée
A special thank to all people living with HIV and HCV who accepted to
participate in the study