Medical, Psychiatric, and Substance Use Comorbidities in HCV Monoinfected and HIV-HCV Coinfected Veterans

Comorbidities, or co-existing conditions - which may include both physical illnesses and mental health issues - often play an important role when making decisions about treatment for chronic hepatitis C virus (HCV) infection.

In a study presented at the at the Digestive Disease Week (DDW) 2008 conference this week in San Diego, researchers attempted to quantify the spectrum of comorbidities in HIV-HCV coinfected compared with HCV monoinfected individuals.

The investigators assembled a cohort of HCV infected subjects from the Veterans Affairs (VA) National Patient Care Database using ICD-9 diagnostic codes. HCV monoinfected and HIV-HCV coinfected patients were compared, and the odds of being diagnosed with various comorbidities were determined adjusting for age, sex, and race.

Results

• The researchers identified 134,905 HCV infected subjects, of whom 7615

• (5.6%) were also HIV positive.

• The HIV-HCV coinfected patients were more likely to be younger, black, and male.

• Coinfected patients were more likely to be diagnosed with anemia, hepatitis B, depression, and drug and alcohol use.

• However, they were less likely to be diagnosed with coronary artery disease (9.1% vs 13.7%), peripheral vascular disease (3.7% vs 4.6%), hypertension (41% vs 48.6%), and diabetes (17.6% vs 20.8%) (P<0.0001).

• After adjusting for age, race, and sex, the odds of diagnosis for the following conditions were lower in the HIV-HCV coinfected subjects:

• Coronary artery disease: OR 0.78;
• Hypertension (OR 0.83);
• Diabetes (OR 0.92).

• The odds were higher in coinfected patients for diagnosis of stroke, anemia, hepatitis B, mild depression, major depression, schizophrenia, drug use, and alcohol use.

• HIV-HCV coinfected patients were more likely to have 5 or more comorbid diagnoses compared with HCV monoinfected subjects.

Conclusion

"The patterns of comorbidities are different in HCV and HCV-HIV coinfected subjects," the investigators concluded. "These have potential management and therapeutic implications, and should be taken into account when designing new intervention strategies."

5/20/08

Reference
A Kahloon, M Skanderson, K Mcginnis, and others. Medical, Psychiatric and Substance Use Comorbidities in HCV and HCV-HIV Coinfected Persons. Digestive Disease Week (DDW) 2008. San Diego, CA. May 17-22, 2008. Abstract T1019.