Effect of opioid-substitution therapy and mental health counseling on HIV risk among hepatitis C-infected individuals

Zahid A Butt,1 Nabin Shrestha,1 Dionne Gesink,2 Michelle Murti,2,3 Jane A Buxton,1,4 Mark Gilbert,4 Robert F Balshaw,4 Stanley Wong,4 Margot Kuo,4 Jason Wong,1,4 Amanda Yu,4 Maria Alvarez,4 Hasina Samji,4 David Roth,4 Theodora Consolacion,4 Mark W Hull,5,6 Gina Ogilvie,1,4 Mark W Tyndall,1,4 Mel Krajden,1,4,7 Naveed Z Janjua1,4 1School of Population and Public Health, University of British Columbia, Vancouver, BC, 2Dalla Lana School of Public Health, University of Toronto, 3Public Health Ontario, Toronto, ON, 4Clinical Prevention Services, British Columbia Centre for Disease Control, 5Division of AIDS, Faculty of Medicine, University of British Columbia, 6AIDS Research Program, British Columbia Centre for Excellence in HIV/AIDS, 7BCCDC Public Health Laboratory, Vancouver, BC, Canada Background: Understanding differences in HIV incidence among people living with hepatitis C virus (HCV) can help inform strategies to prevent HIV infection. We estimated the time to HIV diagnosis among HCV-positive individuals and evaluated factors that could affect HIV-infection risk in this population.Patients and methods: The British Columbia Hepatitis Testers Cohort includes all BC residents (~1.5 million: about a third of all residents) tested for HCV and HIV from 1990 to 2013 and is linked to administrative health care and mortality data. All HCV-positive and HIV-negative individuals were followed to measure time to HIV acquisition (positive test) and identify factors associated with HIV acquisition. Adjusted HRs (aHRs) were estimated using Cox proportional-hazard regression.Results: Of 36,077 HCV-positive individuals, 2,169 (6%) acquired HIV over 266,883 years of follow-up (overall incidence of 8.1 per 1,000 person years). Overall median (IQR) time to HIV infection was 3.87 (6.06) years. In Cox regression, injection-drug use (aHR 1.47, 95% CI 1.33–1.63), HBV infection (aHR 1.34, 95% CI 1.16–1.55), and being a man who has sex with men (aHR 2.78, 95% CI 2.14–3.61) were associated with higher risk of HIV infection. Opioid-substitution therapy (OST) (aHR 0.59, 95% CI 0.52–0.67) and mental health counseling (aHR 0.48, 95% CI 0.43–0.53) were associated with lower risk of HIV infection.Conclusion: Injection-drug use, HBV coinfection, and being a man who has sex with men were associated with increased HIV risk and engagement in OST and mental health counseling were associated with reduced HIV risk among HCV-positive individuals. Improving access to OST and mental health services could prevent transmission of HIV and other blood-borne infections, especially in settings where access is limited. Keywords: opioid-substitution therapy, mental health counseling, HIV, risk, hepatitis